OFFICE OF STUDENT AFFAIRS

General Luna Road, Baguio City Philippines 2600

Telefax No.: (074) 442-5367 Website: www.ubaguio.edu E-mail Address: osa@ubaguio.edu

CHECKLIST for CMO 63 series 2017 and DepEd Order 66 series 2017
(To be attached to the OSA Pre-Activity Form {PAR})

Requirements Proof Complied Remarks

(To be accomplished by (Y/N)
Personnel- To be accomplished by Program
incharge/Coach/Adviser) Chair/Assistant Principal/Dean/Principal
a.1.1. Approved curriculum/
course syllabus
a.1.2. Itinerary
a.1.3. Reminders/Guidelines
for the activity
a.1.4. Consent form
a.1.5. Medical clearance
a.1.6. Personnel-in-charge
a.1.7. First aid kit
a.1.8. Fund source and
breakdown of expenses
a.1.9. Insurance certificate of
coverage
a.1.10. Mobility of students
a.1.11. Acknowledgement
letters to LGUs/NGOs to be
visited
a.1.12: Proof of pre-off-campus activities:
a.1.12.1. Conference with
concerned participants
and other stakeholders
a.1.12.2. General orientation
of participants
a.1.12.3. Acknowledgement
slips of parents/guardians on
the activity
a.1.12.4. Pre-departure
briefing
a.1.12.5. List of
requirements from the
activity
a.1.12.6. Emergency
preparedness plan

Accomplished by: _____________________________ Endorsed by:_____________________

Personnel-in-charge/Coach/Adviser OSA, Director

Assessed by: _______________________ Concurred by: _________________

Program Chair/Assistant Principal Dean/Principal

Approved by:

__________________________________
Vice President for Academic Affairs