Unit/Persatuan/Kelab:
2.
Tarikh: .............................
3.
.....................................................................
Masa: .......................
......................................
iv.
......................................
ii. ......................................
v.
......................................
iii. .......................................
vi.
......................................
4.
5.
Tajuk aktiviti:
............
..............
..................................................................................
Bahagian B (Aktiviti):
1.
Persediaan pelajar.
2.
Penumpuan pelajar.
3.
Penglibatan pelajar.
4.
Aktiviti kumpulan.
Baik
Sederhana
Lemah
Baik
Sederhana
Lemah
Bahagian C (Guru):
1.
Persediaan guru.
2.
3.
Keberkesanan aktiviti.
Ulasan / Cadangan:
Tandatangan
Pemantau: ..................................
(
)