Here is the proper guidance on the DepEd Anecdotal Record Form — including its purpose, required contents, and how to obtain an official sample.
Below is a realistic, fillable template. You can copy this exact format into MS Word or Google Docs to create your own professional form.
A: No. Only for students who exhibit consistent, significant, or unusual behavior patterns (e.g., frequent absenteeism, sudden withdrawal, chronic cheating, or outstanding acts of kindness). Do not create records for minor, one-time issues (e.g., forgetting a pencil once).
ANECDOTAL RECORD FORM
School: ________________________________________________
School Year: _________________ District: _________________
I. LEARNER INFORMATION
| Field | Details | | :--- | :--- | | Full Name: | (Last, First, Middle) | | Learner Reference No. (LRN): | | | Grade Level: | | | Section: | | | Age: | Sex: ☐ Male ☐ Female |
II. INCIDENT REPORT
| Field | Details | | :--- | :--- | | Date of Incident: | | | Time: | | | Location: | (e.g., Classroom, Canteen, Quadrangle) | | Category of Incident: | ☐ Academic ☐ Behavioral ☐ Social ☐ Safety/Child Protection | sample deped anecdotal record form download
III. OBJECTIVE NARRATIVE (Facts only. No assumptions or emotions.)
Describe exactly what happened. What did you see? What exact words did the student say? Who else was present?
Example: At exactly 9:30 AM during the Math quiz, Student A was seen by the teacher looking at Student B’s answer sheet three times. When the teacher approached, Student A immediately covered his own paper.
(Write your narrative here:)
IV. TEACHER’S OBSERVATION & INTERPRETATION
Based on the learner’s age and grade level, what might this behavior mean? (Backed by developmental standards)
Example: The behavior suggests difficulty with assessment content, leading to reliance on peers, rather than intentional cheating with malice.
(Write your interpretation here:)
V. ACTION TAKEN
Check all that apply:
Narrative of Action:
VI. SIGNATURES
| Role | Name & Signature | Date | | :--- | :--- | :--- | | Class Adviser | | | | Learner | | | | Parent/Guardian | | | | Guidance Counselor (if referred) | | |
Below is a complete, ready-to-use sample template. You can copy this into Microsoft Word or Google Docs and print.
Republic of the Philippines
Department of Education
Region [ ] – [School Division Name]
[School Name]
ANECDOTAL RECORD
Learner Information:
Name: _______________________________ Grade/ Section: ________
LRN (Learner Reference Number): _________________ Date of Birth: ____________
Gender: _____ Parent/Guardian: ______________________ Contact No.: ____________
Observation Details:
Date & Time of Incident: ____________________ Place: ____________________
Observer (Teacher/Staff): __________________ Subject/Activity: ____________ Here is the proper guidance on the DepEd
Narrative Description of Incident (What was observed? Be factual, specific, and objective):
Interpretation / Analysis (Possible reason/s for the behavior, if known):
Action Taken (Check all that apply):
☐ Conference with learner
☐ Notified parent/guardian (Date: ______)
☐ Referred to Guidance Counselor (Date: ______)
☐ Developed behavior intervention plan
☐ Other: ________________________
Follow-up / Recommendation:
Signature of Observer: ____________________ Date: ________
Signature of Parent/Guardian: _______________ Date: ________
Signature of Guidance Counselor (if applicable): _______________
Anecdotal records are not just for misbehavior. Document positive incidents too:
Describe what the child did, not what you think the child is. Avoid labels like “bully,” “crybaby,” or “genius.” Instead: “Mark pushed the chair aggressively” (not “Mark is aggressive”).