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Observation Date: ___________________________

Student Name: ______________________________


Description of the incident:
______________________________________________________________________________
______________________________________________________________________________
Description of the location/ setting:
______________________________________________________________________________
______________________________________________________________________________
Notes/ Recommendations/ Actions:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Observation Date: ___________________________
Student Name: ______________________________
Description of the incident:
______________________________________________________________________________
______________________________________________________________________________
Description of the location/ setting:
______________________________________________________________________________
______________________________________________________________________________
Notes/ Recommendations/ Actions:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

TIB-O ELEMENTARY SCHOOL


ABUYOG EAST DISTRICT

ABUYOG, LEYTE

Recorded by:

ARLETTE B. ALVERO
Class Adviser

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