Sample recording form for information about observations*
Employee’s name: _____________________________________________________________________________
Date of Observation ______________________________________
Observer _______________________________________________
Grade __________Period/Time
Was the observer present for full period? _____________________
If NO, _______________ time entered _______________ time left
Course title _____________________________________________
Number of students: _________________ Absent ___________Late
Total on roll ____________________________________________
Materials used: __________________________________________
Unusual occurrences during the observation, causing distraction:
Abbreviated schedule Disturbance in hall
Extended period Shortened period
Weather Fire drill
Presence of observer Fight in class
Other (specify) __________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
What was the purpose of the lesson? _________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
What methods were used? _________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
Was homework assigned? YES NO
If YES, what was assigned? _________________________________
_______________________________________________________
In your opinion was the lesson successful? YES NO
Based on what? __________________________________________
_______________________________________________________
60 – AR Handbook
Would you present the lesson in the same manner in the future?
_______________________________________________________
_______________________________________________________
_______________________________________________________
General ability of the class (in your opinion):
_______________________________________________________
_______________________________________________________
_______________________________________________________
General conduct and cooperation of the class during the period
observed:
_______________________________________________________
Specify, in your opinion, any unusual characteristics of this class:
_______________________________________________________
_______________________________________________________
_______________________________________________________
Description of the lesson: __________________________________
_______________________________________________________
_______________________________________________________
Employee comments: _____________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
Employee signature: ______________________________________
Received by (AR signature): ________________________________
Date: __________________________________________________
Date employee received written observation: __________________
Date conference was held with the observer: ___________________
Date signed observation (with teacher comments)
was returned to the observer: _______________________________
Employee feels observation was fairly done. YES NO
*Please note that this form is generic. It can be changed to apply to
other certified and non-certified employees.