QUESTIONNAIRE

Name (optional): _____________________Position: Teacher II Department: SHS

School: San Julian NHS District: III Division: Pangasinan I
Performed School-based Learning Action Cell (SLAC) Role/s:
( ) SLAC leader ( ) SLAC documenter (/) SLAC member
( ) SLAC facilitator ( ) SLAC resource person ( ) SLAC Focal Person

Part I. To establish the profile of the school where you work, please provide the
information being asked by: a) putting a check mark (/) on your response for items A
and B; and b) filling out the blanks with the correct data for Items C to E.
A. Funding Source/s
(/ ) MOOE ( ) LGU ( ) Individual Donor
( ) Canteen ( ) NGO ( ) Others Pls. Specify:_______
( ) PTA ( ) Private Companies _______
B. Available Facility/ies
( /) Regular Classroom Facilities
( /) ICT Facilities
( ) Science Laboratory Facilities
( ) Home Economics Facilities
( ) Industrial Arts Facilities
( ) Agricultural Arts Facilities
( ) Special Education Facilities
( /) Library Facilities
(/ ) School Library ( ) Teachers’ Professional Library
( ) Classroom Library ( ) Learning Resource Center (LRC)
(/ ) Sanitary Facilities
(/ ) Toilet Facilities (/ ) Handwashing Facilities
( ) Drinking Facilities ( ) Water System and Wastewater Disposal System
( ) Playground Facilities
(/ ) Playground Area (/ ) Playground Equipment
( ) Administrative Facilities
(/ ) School Administrator’s Office (/ ) Receiving Area
(/ ) Working Area for the Staff (/ ) Conference Room
(/ ) Faculty Room (/ ) Supply Storeroom
( ) Production Room ( ) Toilet and Bath
( ) Facilities for Ancillary Services
(/ ) School Health Clinic (/ ) Guidance and Counselling
( ) Canteen
( ) Dining Space (/ ) Service Counter (/ ) Kitchen
( ) Others Pls. Specify:___________________________________
C. Number of Teachers for School Year 2018-2019
( ) 15 and below
(/ ) 16 – 30
( ) 31 – 50
( ) 51 and above
D. Number of Students Enrolled for School Year 2018-2019
( ) 100- 300
 (/ ) 301-600
( ) 601- 900
( ) 901- 1200
( ) 1201 – 1500
( ) 1501- 1800
( ) 1801- 2100
( ) 2101 and above
E. Number of School-based Learning Action Cell (SLAC) Trainings Conducted per
Subject for School Year 2018-2019
English ___________ AP ____________ Filipino ___________
Math ___________ ESP ___________ TLE ____________
Science ___________ MAPEH ____________

Part II. Please put a check mark (/) under the appropriate column to rate the
statements about the School-based Learning Action Cell (SLAC) which your school
implemented for School Year 2018-2019. Use the values below as your reference.
Numerical
Descriptive Values Descriptions
Values
5 = Fully Implemented 81-100 %
(FI) implementation of the indicator
4 = Implemented 61-80 %
(I) implementation of the indicator
3 = Moderately Implemented 41-60 %
(MI) implementation of the indicator
2 = Slightly Implemented 21-40 %
(SI) implementation of the indicator
1 = Not Implemented 1-20 %
(NI) implementation of the indicator
FI I MI SI NI
Indicators
(5) (4) (3) (2) (1)
SLAC Implementation Process
Before the session, the SLAC conducted had:
1. assessed the needs with reference to the /
professional career standards
2. prioritized topics or agenda from the needs /
that were identified
3. involved 5 to 15 members with similar /
prioritized need/s
4. specified the roles of the members, namely, /
leader, facilitator, documenter, resource
person, member
5. identified the appropriate intervention/s (such /
as but not limited to strategies in teaching,
program, learning materials, instructional
materials, facilities) to address the need/s
6. scheduled a one to two hours a week /
meetings and at least once a month session
 7. set up human and material resources needed /
before the implementation of the session
8. developed and adhered to implementation /
norms which pertain to time and venue,
listening, confidentiality, decision making, and
participation
9. prepared line-item budget in accordance with /
the existing accounting rules and regulations
10. written and documented the plan using the /
template given or its modification
11. linked or integrated the plan with School /
Improvement Plan (SIP) or Annual
Implementation Plan (AIP)
FI I MI SI NI
Indicators
(5) (4) (3) (2) (1)
During the session, the SLAC conducted had:
1. implemented the plan through a variety of /
activities such as but not limited to lectures,
practicum, coaching, workshops, and
development and utilization of instructional
materials
2. conducted a collaborative discussion on /
possible ways forward
3. prepared individual or group action plan in /
order to implement agreed activities in the
classroom/school/community
After the session, the SLAC conducted had:
1. implemented the proposed strategies or /
activities in their classroom/school/community
2. monitored and evaluated how far the /
strategies or activities are contributing to
improved outcomes for learners at school
through the facilitators and leader
3. reported back the success of the implemented /
strategies or activities in the succeeding
sessions through the members
4. carried-out the improvement of the teaching- /
learning process
5. nurtured successful teachers /
6. enabled teachers to support each other to /
continuously improve their content and
pedagogical knowledge, practice, skills, and
attitudes
7. fostered a professional collaborative spirit /
among school heads, teachers, and the
community as a whole
8. carried-out the improvement learning among /
 the students

Part III. Please put a check mark (/) under the appropriate column to evaluate the
extent of seriousness of the problems encountered relative to your school’s
implementation of the School-based Learning Action Cell (SLAC) for School Year 2018-
2019. Use the values below as your reference.
Numerical Descriptive Values Descriptions
Values
5 = Very Highly Serious 81-100 % extent of seriousness of the indicator
(VHS)
4 = Highly Serious 61-80 % extent of seriousness of the indicator
(HS)
3 = Serious 41-60 % extent of seriousness of the indicator
(S)
2 = Slightly Serious 21-40 % extent of seriousness of the indicator
(SS)
1 = Not Serious 1-20 % extent of seriousness of the indicator
(NS)

VHS HS S SS NS
Indicators
(5) (4) (3) (2) (1)
Before the School-Based Learning Action Cell (SLAC) Session
1. Needs were poorly assessed /
2. Topics or agenda were poorly prioritized /
3. SLAC formed exceeded the ideal number of 5 /
to 15 members
4. Interventions expected to address the /
identified need were inappropriate
5. No meetings were held before the SLAC /
session
6. Human and material resources needed were /
not prepared before the SLAC session
7. Specific roles of the SLAC members were not /
properly assigned
8. SLAC implementation of norms were not /
properly established
9. Line-item budget were poorly prepared /
10. Absence of written plan to guide the SLAC /
Implementation
During the School-Based Learning Action Cell (SLAC) Session
1. Single activity was utilized in the /
implementation of the SLAC plan/s
2. Collaborative discussion about possible ways /
forward was not performed
3. Individual or group action planning was not /
part of the session
After the School-Based Learning Action Cell (SLAC) Session
1. 1. Proposed strategies or activities in the /
classroom/school/community were not
implemented
2. SLAC’s contribution to the improvement of /
instructional skills of teachers were not
monitored and evaluated by the SLAC leader
and facilitators
3. SLAC’s contribution to the improvement of /
learning outcomes was not monitored by the
school heads