Republic of the Philippines

DEPARTMENT OF EDUCATION
Region IV-A CALABARZON
DIVISION OF RIZAL

INSTRUCTIONAL SUPERVISION MONITORING AND EVALUATION (ISME) REPORT

For the period covered ________________

Note to the user of this form:

1. This form shall contain the report of all the conducted Instructional Supervisions (IS) for the whole month including those who are still under follow-up.
2. The name of the school head/s under follow-up stage should appear depending on the number of times IS has been provided with the corresponding needed information asked therein.
3. IS provider should make it sure that IS follow-up should be made within two (2) weeks after the last IS provision.
4. Submit this duly accomplished form to the CID chief via Google Drive provided every end of the month.

Name of School Date of IS Strength/s Areas for Improvement Agreement/s Status Date of
School Head Provision (Closed or Follow-up
for Follow- (If
up) necessary)

Prepared by:

_____________________
EPS/PSDS

DepEd Bldg., Cabrera Road, Brgy. Dolores Taytay, Rizal 1920 * Contact Numbers: SDS 571-4284 / ASDS 650-2615 / CID 650-2610 /
ADMIN 650-2639 / FINANCE 650-2612 / SUPPLY 695-3877 / SGOD 7061720
email: rizal@deped.gov.ph Facebook: DepEd Rizal Website: depedrizal.ph
DOR-CID-F-017 Rev. 00 November 6, 2020

Not to be reproduced or photocopied without prior authorization of SDO Rizal.