Science Lab Forms

Republic of the Philippines
Department of Education
Curriculum and Learning Management Division
Appendix 1
Form 1.0 - Equipment/Apparatus Loan Requisition Form
Date Borrowed: _____________

Date Returned: _____________
Group No.: _____
Year/Section: _____________
Name of Borrower/s: ___________________________ ___________________________
___________________________ ___________________________
___________________________ ___________________________
Phone Number & Email of Group Leader: ________________________________________
Item(s) and Quantity Being Borrowed (use separate sheet if needed):
Item Name Quantity Specification Condition prior Condition after
to borrowing borrowing
Ex. beaker 1 pc. 50 ml (Pyrex) Good
Purpose of Borrowing Equipment/Apparatus (Please Check):

□ Research □ Class Project □ Teaching □ Experiment □ Competition
Place of Use: □ Inside the Laboratory □ In a Classroom □ Out of School
_____________________________ __________________________
Project Supervisor/Teacher Checked by Lab In-charge
(Name & Signature) (Name and Signature)
DECLARATION:
I/We have asked to borrow the above stated item(s) belonging to the Science
Laboratory. I understand that all the items will be used for teaching-learning activities,
research and competition purposes only.
I/We agree to return the item(s) by the date stated above.

I/We understand that I am responsible for the safe keeping of the item(s).
I/We understand that if I fail to return the item(s) stated above by the agreed date,
I/We can be charged for theft and/or misuse of school property.
I/We understand that I/We am/are responsible for replacing the item(s) with the same
SCIENCE LABORATORY FORM

kind and specification if it is damaged, lost or stolen caused by recklessness or
carelessness during the experiment. Replacement must be done as soon as possible or
until the end of the school year.
I/We understand that I/we can be spared from replacing the broken, damage or loss
tools/equipment due to uncontrollable situations/accidents or calamities during the
experiment with the guidance and appropriate incident report of the subject
teacher/laboratory in-charge.
TERMS & RULES OF APPLICATION

1. This form must be completed and submitted to the laboratory in-charge at least one
day in advance; incomplete form will not be entertained.
2. All equipment & items to be borrowed are subject to availability and vacancy.
3. Prior approval from project supervisor/teacher is needed to obtain the item(s) above.
4. The laboratory in-charge has the right to request the borrower to return the loaned
item(s) at any time.
5. The borrower/s (learner/teacher) maybe responsible for replacing the item(s) if it is
damaged, lost or stolen due to recklessness or negligence;
6. An incident report should be made if the borrowed item/s is/are broken, loss or
damaged.
7. The equipment/apparatus should not be taken out from premises unless authorization
from the Property Custodian and the Principal is obtained.
Group Leader’s Printed Name & Signature: ______________________ Date: _____________________
Cc: Parents/Guardians (when there is issue on lost and breakage)
SCIENCE LABORATORY FORM

Appendix 2
Form 1.1 Scoring Sheet for Class Experiment
Names of Learners:
Date:
Subject:
Title of the Experiment:
Scoring Scale
4- Expectations Exceeded 19-20 –Exceptional
3- Expectations Met 16-18- Satisfactory
2- Basic Standards Somewhat Met 12-15 –Needs Improvement
1-Below the Minimum Standards 01-11- Inadequate
Instruction. Put Checkmark on appropriate rating 4 3 2 1
Experimental Hypothesis
Based upon the purpose of the experiment, the
hypothesized relationship between variables and predicted results is
clear and reasonable.
Experimental Designs + Materials
Experiment conveys a thorough analysis of the problem and has been
conducted thoughtfully. All materials and setup employed are
accurately described. All images, graphic elements, diagrams, charts,
drawings, etc., are clear and pertinent.
Data Collection + Procedures
Data has been collected and recorded accurately and conveyed in an
orderly manner to accurately reflect results. Clear steps are listed to
define all procedures.
Analysis
Thoughtful analysis discusses the relationship between variables.
Trends and patterns are logically analyzed. Predictions are made
regarding varying outcomes as a result of alterations to the
experiment.
Scientific Results + Conclusions
The solution to the problem is explained with convincing clarity.
Sources are cited appropriately. Conclusion explains whether or not
the hypothesis was supported by the findings. Possible sources of
error are detailed, if applicable. Clearly expresses what was learned
from the experiment.
Column Total
Total Score
GUIDELINES IN THE UTILIZATIONF OF LEARNING RESOURCES IN SCIENCE LABORATORY

Name and Signature of the Teacher: ________________________ Date: __________________

Appendix 3
Form 1.2 Breakage Report Form
1) Learner/s’ Details
Learner/s Name Contact
Grade Level
Section:
2) Description of Incident
Date of Incident Time
Lab Room No. and
Name
Subject Teacher
Item Specifics
Nature of the Incident _____Uncontrollable Incident ____Recklessness
Description of Incident
(Describe the incident
in detail) provide
additional sheet if
necessary.
Appropriate Action _____ For School Report/Inventory Only _____For Replacement
Name and Signature

Science Laboratory in
Charge or Science
Teacher

3. Cost of the item
Fill-in this data only if the replacement is charge to learners/teachers after incident
report has been made and considered, otherwise, this data is not necessary.
Item Specifics Count Cost
Total
Verified by the Lab In-Charge/Teacher: Name and Signature
3) Declaration by the Learners
I/We
_________________________________________________________________________________________
_____________________________________________________________________________________have
fully read, understand and agree to abide for the “Replacement Charges - Breakage,
Damage or Loss of Laboratory Item” in which the school holds the right to take necessary
action.
Signatures of Learners: Date: ___________
________________________________________________________________________
4) Declaration by the Parents
I/We
_________________________________________________________________________________________
_____________________________________________________________________________________
fully understand that our children are responsible for replacing the damage or loss of the
borrowed science tools, equipment or learning resources under the care of the school based
on the breakage and incident report. Hence, by extension we are taking the responsibility
to provide financial support or/and take effort in the replacement in compliance to the lost
or damaged item/s.
Signatures of Parents: Date: ______________

____________________________________________________________________________________

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Republic of the Philippines

Form 1.0 - Equipment/Apparatus Loan Requisition Form

Date Borrowed: _____________

Purpose of Borrowing Equipment/Apparatus (Please Check):

I/We agree to return the item(s) by the date stated above.

SCIENCE LABORATORY FORM

TERMS & RULES OF APPLICATION

Group Leader’s Printed Name & Signature: ______________________ Date: _____________________

Cc: Parents/Guardians (when there is issue on lost and breakage)

SCIENCE LABORATORY FORM

Form 1.1 Scoring Sheet for Class Experiment

GUIDELINES IN THE UTILIZATIONF OF LEARNING RESOURCES IN SCIENCE LABORATORY

Name and Signature of the Teacher: ________________________ Date: __________________

Form 1.2 Breakage Report Form

Nature of the Incident _____Uncontrollable Incident ____Recklessness

Name and Signature

GUIDELINES IN THE UTILIZATIONF OF LEARNING RESOURCES IN SCIENCE LABORATORY

3. Cost of the item

Item Specifics Count Cost

Verified by the Lab In-Charge/Teacher: Name and Signature

3) Declaration by the Learners

Signatures of Learners: Date: ___________

4) Declaration by the Parents

Signatures of Parents: Date: ______________

GUIDELINES IN THE UTILIZATIONF OF LEARNING RESOURCES IN SCIENCE LABORATORY

GUIDELINES IN THE UTILIZATIONF OF LEARNING RESOURCES IN SCIENCE LABORATORY

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Group Leader’s Printed Name & Signature: __ Date: _

Name and Signature of the Teacher: ______ Date:

Nature of the Incident _Uncontrollable Incident Recklessness