Republic of the Philippines

Department of Education
Region VIII
Division of Samar

STO. NIÑO NATIONAL HIGH SCHOOL

Sto. Niño, Samar

FEEDBACK MONITORING TOOL

DISTANCE MODULAR LEARNING (PRINT)

Name of Student : __________________________________________________

Name of Parent : __________________________________________________
School : __________________________________________________
District/Cluster : __________________________________________________
Learning Area/Subject : __________________________________________________
Subject Matter/Lesson : __________________________________________________
Date : __________________________________________________

Objective:
 To assess the implementation of Distance Modular Learning instruction as an
alternative learning delivery modality
End Users:
 Students/Learners; Parents/Guardians
Directions: Please assess the level of observance to the following indicators by putting
checkmark (✓) under the appropriate column. Refer to the rating scale below.
1 – To a very small extent
2 – To a small extent
3 – To a moderate extent
4 – To a large extent
5 – To a very large extent

Parents/ Students Feedback on Modules Distributed

Indicators 1 2 3 4 5
1. Provides for elaborated and detailed presentation and
explanation of the topic
2. Provides sufficient examples and illustrations relevant to the
lesson
3. Contains visually rich and appropriate texts, pictures, images,
graphics, materials, and resources
4. Uses appropriate language and content that are easy to
understand
5. Relates lessons with real life situations
6. Integrates values/character building
7. Captures learners’ interest and attention
8. Elicits learner interaction and participation
9. Allows learners adequate time to process information and
answer questions about the topic
10. Makes learning fun and enjoyable
11. Assists in providing enriching learning opportunities and
experience
12. Provides for properly sequence of topic
13. Shows evidence of careful planning and preparation
 14. Qualifies as an effective tool/medium for learning
15. Provides for an alternative, complementary medium of
instruction accessible to all

Observation of Student’s Home Learning Environment:

YES NO MOVs/Remarks
1. Class Schedule Posted and Follow ______ ______ _______________
2. QR Code of Parents for Module Distribution ______ ______ _______________
3. Self-Learning Materials Properly Arrange ______ ______ _______________
4. Student Learning Table ______ ______ _______________
5. Home Learning Environment Properly Ventilated ______ ______ _______________
6. Home Learning Environment quiet and noise free ______ ______ _______________
7. Availability of Para Teacher ______ ______ _______________
8. Observing safety and health protocol ______ ______ _______________

*attach picture of learner’s home learning environment

Critical Observations:

1. Was the message conveyed or communicated? Why? Why not?

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2. What important/key concepts did you learn?

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3. Comments/Suggestions

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Observed By: Validated By:

_______________________ FERNANDO F. MARAÑON, JR.

Class Adviser Principal IV