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Province Rizal
Division Rizal
District Tanay IB
Name of School Tanay West NHS
School Address G. Trinidad St., Brgy Wawa, Tanay, Rizal
Total Enrolment 42
Grade Level and Section 7 Dahlia
DEWORMED
Number Refused
Name of Child with consent
Enrolled Deworming
Precautionary Measure
(seriously ill, with abdominal
Deferred pain, diarrhea, who has
previous hypersensitivity
with deworming drug)
(Name and Signature)
Province RIZAL
Division TANAY
District TANAY
Name of School TANAY WEST NATIONAL HIGH SCHOOL
School Address G. TRINIDAD ST. BRGY. WAWA TANAY, RIZAL
Total Enrolment
CHILDREN DEWORMED
Grade 7
Grade 8
Grade 9
Grade 10
Grade 11
Grade 12
TOTAL
Noted By:
Accomplished By:
Date Accomplished:
worming Month July 2016
d School Level Reporting Form
Precautionary Measure
(seriously ill, with Remarks
abdominal pain, diarrhea, ( Reasons for
who has previous Refusals and being
hypersensitivity with deferred )
deworming drug)
National School Deworming Month July 2016
ANNEX C : Form 2 Modified School Level Reporting
Province RIZAL
Division RIZAL
District TANAY I
Name of School TANAY WEST NATIONAL HIGH SCHOOL
School Address G. TRINIDAD ST. BRGY. WAWA TANAY, RIZAL
Total Enrolment 597
CHILDREN
Remar
DEWORMED
No. of Enrolled
Grade Level with consent Ineligible
Chidren
4 P's non 4 P's ( Dewormed
before June 1)
Grade 7
Grade 8
Grade 9
Grade 10
Grade 11
TOTAL 0 0 0 0 0
Accomplished By:
LYNDEL R. DAVID
Principal I
Precautionary
Measure (seriously ill,
with abdominal pain,
Refused Deferred due to
diarrhea, who has
Deworming Prevalence Survey
previous
hypersensitivity with
deworming drug)
0 0 0
Noted By:
IMELDA M. ASUNCION
District Supervisor
Date Accomplished: