(Enclosure No. 1A to DepEd Memorandum No. 59, s.

2015)

(To be submitted to the Division Office a week after the start of each school year)

School - Based Reort on Incidents of Bullying

School Year 2018 - 2019

School: Jesus Son of Mary Academy

Address: Our Mother of Perpetual Help Parish, San Manuel II, City of Dasmariñas

Date / Place Cyber Sex

Physical Social Gender Based Retaliation Name Age
of Incident Bullying (M/F)

* Physical - unwanted physical contact (punching, shoving, pushing, kicking, slapping, tickling, headlocks etc.)
Note: Bullying is perpetrated
* Socia by deliberate,
- refers to any a student against another
repetitive studentsocial
and aggressive, whichbehavior
may be:intended to hurt or belittle an individual
* Gender-Based - refers to any act that humiliates or excludes a person on the basis of perceived or actual sexual or
* Cyber Bullying - any bullying done through the use of technology or any electronic means (texting, email, chatting

Reviewed and Conformed by: Miss Divina G. Oliveros / Principal

Name and Designation

Date:
 Annex "A"

s of Bullying
9

Classification: (Private/Public) Private

Level: (Kindergarten/Elementary/Secondary) Kindergarten/Elementary/Secondary

Status
(Resolve/Pen
Sex Action
Name Age Recommendation ding/Referred
(M/F) Taken
to other
agency)

, headlocks etc.)
or belittle an individual (name-calling, cursing, labelling, etc.)
ved or actual sexual orientation and gender identity
texting, email, chatting, online games, etc.)

Prepared by: Mrs. Marilou M. Cabigayan / Discipline Officer

Name and Designation

Date:
(Enclosure No. 1B to DepEd Memorandum No. 59, s. 2015)

(To be submitted to the Division Office a week after the start of each school year)

School - Based Reort on Incidents of Child Abuse

School Year 2018 - 2019

School: Jesus Son of Mary Academy

Address: Our Mother of Perpetual Help Parish, San Manuel II, City of Dasmariñas

Nature of Abuse Victims Pe

Date of Incident Verbal / Name (Last Name, First Name, Sex Name (Last Name, F
Physical Sexual Age
Psychological M.I.) (M/F) M.I.)

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 their physical well-being.
* Sexual - refers to acts that are sexual in nature such as rape, sexual harassment, sexually demeaning remarks, forcing children to watch obscene publi
* Psychological - refers to acts or omissions causing or likely to cause mental or emotional suffering to the child which include intimidation, harassment
threat or deduction from grade orment as a form of punishment, and repeated verbal abuse.
* Relationship to the Victim refers to relatives (father, mother, cousin, etc.) or school personnel (teachers and non-teaching staff)
* No amicable settlement for any acts of child abuse

Reviewed and Conformed by: Miss Divina G. Oliveros / Principal

Name and Designation

Date:
 Annex "A"

buse

Classification: (Private/Public) Private

Level: (Kindergarten/Elementary/Secondary) Kindergarten/Elementary/Secondary

Perpetrators Status
Relationship to Action (Resolve/Pending/Re
(Last Name, First Name, Age
Sex the Victim Taken ferred to other
M.I.) (M/F) agency)

l-being.
h obscene publications or shows etc. and
on, harassment, stalking, public ridiculle,

Prepared by: Mrs. Marilou M. Cabigayan / Discipline Officer

Name and Designation

Date: