Instructional Supervision Form 1

PRE-OBSERVATION INFORMATION
Teacher:____________________________________ School: BADO DANGWA NATIONAL HS
District: WESTERN__________________ Division : _TABUK CITY DIVISION
Grade and Section: ____________________________Subject: ____________________________
School Year: _____________Semester: ___________Conference Date:____________________
Instructional Supervisor:__________________________________________________________

Directions:
1. This form shall be answered by the teacher prior to instructional support visit.
2. The information will serve as guide for the pre-observation conference. Observer may ask additional
job-relevant data to provide a background for actual observation.
3. The filed up form shall be given back to the teacher to be placed in front of the teachers’ observation
Form 3A, B, C which will be used by the observer.
Pre- Observation information:
1. When would you like to have instructional supervision and support?
Date and time: ________________________________________________________
2. Which of your class would you like to be observed?
Class and the period to be observed: ______________________________________
3. What area of domain would you like to be observed? Please check.
DOMAIN Suggested Observation Tool to be Used
___Diversity of learners ___Strategies for diverse learners- quantitative
____Strategies for diverse learners-qualitative
___ Indicators of culturally diverse learners
___Content and Pedagogy ___Star observation technique
___Learning Environment ___Star observation technique
___School, home, community linkages
___Social regard for learning ___Star observation technique
___Personal growth and professional development
___Planning, Assessing and reporting ___Star observation technique
___Others, Specify:_______________________
4. What specific teaching- learning parameters would you like to be focused? Please check.
Teaching-learning parameters Suggested Observation Tool to be Used
___Motivation ___Star observation technique
___Teachers-Learners interaction ___Star observation technique
___Diagram Verbal Interaction/ Teacher
Pupil Interaction
___Diagram of Teacher’s Movement to
assist slow learners
___Questioning / Answering skills ___Teacher Questions
___Pacing of the lesson ___Star observation technique
___Testing ___Star observation technique
___Classroom management ___Teacher Verbal Behavior
___Non-verbal Technique
___Diagram of Teacher Space Utilization
___Teacher Behavior Keyed to Accountable Talk
___Student Behavior Keyed to Accountable Talk
___Tailored Tool
___Time on Task ___Student on Task & Off Task Behavior)
___Planning, Assessing and Reporting ___Star observation technique)
Others, Specify:__________________________

5. What teaching method / strategy will you use?

_________________________________________________________________________

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Instructional Supervision Form 1

6. How would you describe the class you will be teaching during the visit? Please provide
information by checking or filing up the required data.
a. Type of class
( ) Mono grade ( ) 2 class combination ( ) multi grade
b. Size of class
( ) Small class size: Number of Learners_________________________________
( ) Big class size : Number of learners ________________________________
c. Class diversity
( ) Homogeneous (Describe) __________________________________________
( ) Heterogeneous (Describe)_________________________________________
7. What three priority areas in the “self assessment tool for teachers in the delivery of quality
instruction” do you need the most support and assistance?
Please Enumerate and specify?

a. ____________________________________________________________________

b. ____________________________________________________________________

c. ____________________________________________________________________

8. What priority objectives in your IPDP did you include for school year _____________
That you intend to accomplish? Please write.

a. ____________________________________________________________________

b. ____________________________________________________________________

c. ____________________________________________________________________

Submitted by: Noted by:

_______________________ ________________________
Teacher Name and Signature MT, HT SH, PSDS, EPS

Note: this space shall be used for needed information given during the pre-observation but are not included
above.