Republic of the Philippines

Department of Education
REGION III-CENTRAL LUZON
SCHOOLS DIVISION OF SAN JOSE CITY

OPLAN BALIK ESKWELA SY 2020-2021

SCHOOL PREPAREDNESS MONITORING FORM

School: _____________________________________________ Date: _______________________

I. GENERAL HEALTH AND SAFETY PROTOCOLS

Not
Evident Remarks
Evident

1. Before entering the school, the following practices are observed:

1.1. Availability of contact tracing
form/ logbook
1.2. Body temperature checking
1.3. Hand sanitizer/ alcohol
1.4. Disinfection foot bath
1.5. Markers for physical
distancing
1.6. Waiting area
1.7. Safety protocols
announcement posted at the
school’s gate
2. The school personnel:
2.1. Wears facemask
2.2. Wears face shield
2.3. Observes physical distancing
(at least one-meter apart)
3. Work Arrangement
3.1. Adopted alternative work
arrangement for school
personnel based on DepEd
Order No. 11, s. 2020

Address: San Jose-Lupao Road, Sto. Niño 1st, San Jose City, Nueva Ecija
Telephone No.: (044) 8940-9740 E-mail: sanjose.city@deped.gov.ph
Certificate No.: AJA18-0129
 Not
Evident Remarks
Evident

3.2. Issued a school

memorandum on the
alternative work
arrangement
3.3. Set-up workstations of
school personnel compliant
with the minimum health
and safety protocols
3.4. Classroom’s seats are
arranged observing
physical distancing based
on Enclosure No. 5, DepEd
Order No. 14, s. 2020.
4. Physical Facilities
4.1. Availability of functional
handwashing facility (with
soap and water)
4.2. School ground maintenance
4.3. Regular disinfection of
school facilities and
classrooms

II. ENROLMENT DATA, as of ___________September 30_____________________

Grade Level Male Female Total

Kinder 0 0 0
Grade 1 0 1 1
Grade 2 3 4 7
Grade 3 1 2 3
Grade 4 3 3 6
Grade 5 4 2 6
Grade 6 1 3 4
Grade 7 2 6 8
Grade 8 4 8 12
Grade 9 10 11 21

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Grade 10 19 7 26
Grand Total 47 47 94

III. LEARNING MODALITIES DATA

No. of Learners

Grade Level TV-based

Modular Modular Radio-based
Online Instructio
(Printed) (Digital) Instruction
n

K 0 0 0 0 0
G1 0 0 1 0 0
G2 1 0 6 0 0
G3 0 0 3 0 0
G4 0 0 6 0 0
G5 0 0 6 0 0
G6 0 0 4 0 0
G7 2 0 6 0 0
G8 0 0 12 0 0
G9 2 0 19 0 0
G10 3 0 23 0 0
TOTAL 8 0 86 0 0

IV. IMPLEMENTATION OF THE CURRICULUM IN THE NEW NORMAL

Not
Evident Remarks
Evident

1. Conducted planning sessions for

the new normal situation
2. Conducted Advocacy campaign
for the new normal and different
modalities

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 Not
Evident Remarks
Evident

3. Mapped learners per grade level

for desired modality/s
4. Conducted trainings for teachers

5. Teachers attended webinars

conducted by the DO/RO/CO
6. Availability of weekly home
learning plan
7. Availability of Activity/work
sheets
8. Availability of individual
learning monitoring report/plan

9. Availability of Class schedule

10. Inventory and number of

distributed textbooks by
learning area
11. Has a localized guidelines
and/or algorithm on the
DISTRIBUTION of learning
materials (e.g. modules,
flashdrives, worksheets, etc.)
12. Has a localized guidelines
and/or algorithm on the
RETRIEVAL of learning materials
(e.g. modules, flashdrives,
worksheets, etc.)
13. Pick-up and drop-off points of learning materials:
13.1. in school

13.2. in the barangay hall

13.3. designated teacher’s/ school

head’s/ staff’s residence
13.4. Delivered by teachers/school
personnel
13.5. Other modes, specify:

14.Schedule of distribution and

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 Not
Evident Remarks
Evident

retrieval
15.Availability of contact
number(s)/ focal person(s) for
learning materials distribution
and retrieval.
16.Availability of protocols for
the sanitation of modules
before distribution and upon
retrieval.

17. Use of USB-OTG

17.1. Plan for the use of USB-OTG

17.2. Schedule of distribution and

Retrieval of USB
18.Schedule/strategies of SH in
monitoring teacher’s delivery of
learning
19.Validation of modalities
delivered based on the data
submitted
20. Availability of feedback
forms from teachers, parents,
learners, stakeholders for
improvement on materials
and system
21.Gaps and adjustments made

22. Other preparations:

22.1. Internet connectivity

22.2. Video lesson

equipment/studio
22.3. Online classes

22.4. Number of modules prepared

by the teachers
22.5. Number of videos prepared
by the teachers

V. ORIENTATION OF PARENTS/ STAKEHOLDERS

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 Not
Evident Remarks
Evident

1. Conducted Parents’/
Guardians’ Orientation,
Seminar and/ or Training
2. Documents relative to
Conducted Parents’/
Guardians’ Orientation:
2.1. Letter of Information/
email/ chat/ social media post
2.2. Minutes of the Meeting

2.3. activity completion report

(ACR)
3. Availability of parents’
directory

Number of Parents’/ Guardians Oriented/ Trained

Grade Level Male Female Total

VI. NETWORKING AND PARTNERSHIPS

A. Total amount of MONETARY DONATIONS received:

B. Number of IN-KIND DONATIONS received:

Items Number/ Pieces
1. Office Supplies (Please specify below)

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 Bond paper
Printer ink

2. Medical and Sanitation Supplies

Hand sanitizer/ alcohol
Disinfection material/ supply
Facemask
Face shield

3. IT Equipment (Please specify below)

Personal Computer
Printer
Router
Copying Machine
Internet Service Provider

Other In-Kind Donations Received:

Not
Evident Remarks
Evident

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 1. Accomplished Deeds of
Donation for in-kind and
monetary donations.
2. Signed Memorandum of
Agreement (MOA)/
Memorandum of
Understanding (MOU) with
partner institutions.

VII. ISSUES AND CONCERNS

___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Prepared by: Noted:

____________________________ ___________________________
Monitoring SDO Personnel School Head

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