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Republic of the Philippines

Department of Education
REGION XI – DAVAO REGION
SCHOOLS DIVISION OF DAVAO CITY
SIMON NATIONAL HIGH SCHOOL
PUROK 3, CAWAYAN, CALINAN, DAVAO CITY

Explanation for Failure to Log-in/out Form

Date: _________________
To: THE SCHOOLS DIVISION SUPERINTENDENT

Pursuant to Division Order _0255, s. 2013, please be informed that I, ___________________


Failed to Log-in ( ) Actual time of Arrival: _______A.M. ________P.M. Date: _____________
Failed to Log-out ( ) Actual time of Arrival: _______A.M. ________P.M. Date: _____________
For the following reasons: ___________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
(Use separate sheet if necessary)

__________________________________
Employee’s Signature over Printed Name

Witnessed: ________________________ ___________________________

Grade Level Head/Year Level Coordinator: __________________________

Action Taken:
Attested to employee’s 1 st / 2nd time within the
Presence in the office on semester excused
the said date/time ____ times within this
Semester and subject to
Reason cited found valid,

Action taken: _______________________


Reason cited not valid

Recommending Approval: Approved by:

Secondary: Department Head Secondary School: Head/Principal


Division Office: Section Chief Division Office: A.O. / ASDS /SDS

Notary Public:

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