(Enclosure No. 1A to DepEd Memorandum No. 5,s.

2015)
(To be submitted to the Division Office one (1) week after the opening of every school year)

School-Based Rep
S.
BAYOG ELEMENTARY SCHOOL
Tagpuan St.,Brgy. Bayog, Los Baos,Laguna

School:
Address:

Nature of Abuse
Date of Incident
NONE

NONE

Physical

Sexual

NONE

NONE

Verbal/
Psychological
NONE

TOTAL
Note:
* Child Abuse refers to the maltreatment of a child, whether habitual or not, which includes any of the following:

Physical - refers to acts that inflict bodily harm and which subjects children to perform tasks which are hazardous to t

Sexual - refers to acts that are sexual in nature such as rape, sexual harassment, sexually demeaning remarks, forcin

Psychological - refers to acts or omissions causing or likely to cause mental or emotional suffering to the child which i
and repeatead verbal abuse.

* Relationship to the Victim refers to relatives (father,mother, cousin, etc.?) or school personnel (teachers and non-teaching st
* No amicable settlement for any acts of child abuse.

Reviewed and Conformed by:

Date:

MARICAR A. AFUANG
Principal I
June 26, 2015

ening of every school year)

School-Based Report on Incidents of Child Abuse

S.Y. 2014 - 2015
Classification:

os Baos,Laguna

Level:
Victims

Name
(Last Name.Fisrt Name,M.I.)

NONE

Perpetrators
Age
NONE

Sex
(M/F)
NONE

Name

Age

(Last Name.Fisrt Name,M.I.)

NONE

NONE

bitual or not, which includes any of the following:

ch subjects children to perform tasks which are hazardous to their physical well-being;
rape, sexual harassment, sexually demeaning remarks, forcing children to watch obscene publications or shows etc.; and

kely to cause mental or emotional suffering to the child which include intimidation, harassment, stalking, public ridicule, threat of deduction from grade or

ousin, etc.?) or school personnel (teachers and non-teaching staff)

ICAR A. AFUANG
Principal I

Prepared by:
Date:

AIDA C. L
School Guidance
June 26, 201

use
Public
Elementary

s
Sex
(M/F)
NONE

Relationship
to the Victim

Action Taken

NONE

NONE

hreat of deduction from grade or merit as a form of punishment,

AIDA C. LITARGO
School Guidance Counselor
June 26, 2015

Status
(Resolved/Pending/
Referred to other
agency)
NONE

Republic of the Philipp

DEPARTMENT OF EDUC
Region IV - A CALABAR
Division of Laguna
District of Los Bao

BAYOG ELEMENTARY

Dangerous Drugs
Civic Awareness Co

Accomplishment R
Month of __________
Date
NONE

Programs/Projects
Venue
NONE

Activity
NONE

Submitted by:
AIDA C. LITARGO
School Guidance Counselor
Date:

June 26, 2015

Republic of the Philippines

DEPARTMENT OF EDUCATION
Region IV - A CALABARZON
Division of Laguna
District of Los Baos

BAYOG ELEMENTARY SCHOOL

Dangerous Drugs Board

Civic Awareness Committee
Accomplishment Report
Month of __________________

ects

Counselor

Person Responsibility
NONE

Beneficiaries

Resources Used

NONE

NONE

Lead & Partner

Agency
NONE

Challenges
NONE

Recommendations
Remarks
NONE