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All learners under facilitator's care left before facilitator’s time of departure?YesNo

If no, identify learners present at time of departure in the space given bellow:

Were all learners present in school?YesNo

If no, identify absent learner(s) and give reasons for absence in the space bellow.

Did all learners have their lunch?YesNo

If no, identify the learners in the space given bellow and give reason(s) why.

Were there any damages to school properties?YesNo

If yes, indicate the damaged property, the person responsible and an account of what transpired in the space given bellow:

Did a learner sustain an injury or fall sick?YesNo

If yes, identify the learner(s) and reasons in the space bellow:

Facilitator ensured classroom was tidy and in order at time of departure?YesNo

If no, give reason(s) in the space provided bellow:

Add any additional comments you have in the box below. (optional)

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