(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 Report on Incidents of Bullying

School Year 2015-2016
School: Ligaya Elementary School Classification: (Private/Public) Public
Address: Purok 6 Barangay Ligaya GSC Level: (Kindergarten/Elementary/Secondary) Elementary

Nature of Bullying Victims Perpetrator Status

Date/Place Physical Social Gender Cyber Retaliation Name Age Sex Name Age Sex Action Recommendation (Resolved/Pendin
of Incident -Based Bullying M/F M/F Taken g/ Referred to
other agency)
NONE

Note: Bullying is perpetrated by a student against another student which may be:
 Physical- unwanted physical contact (punching,shoving,pushing,kicking,slaping,tickling,headlocks etc.
 Social-refers to any deliberate, repetitive and aggressive social behavior intended to hurt or belittle an individual(name calling,cursing,labellng,etc.
 Gender- Based-refers to any act that humiliates or exclude a persons on the basis of perceived or actual sexual orientation and gender identity
 Cyber Bullying-any bullying done through the use of technology or any electronic means (texting,email,chatting,online games etc.)

Prepared by:
ELMER G. TORADO
School Guidance Coordinator

Date: June 29, 2015

Reviewed and Conformed by:

ZENAIDA A. CAUSING
Principal I

Date: June 29, 2015

(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 Report on Incidents of Bullying

School Year 2015-2016
School: Ligaya Elementary School Classification: (Private/Public) Public
Address: Purok 6 Barangay Ligaya GSC Level: (Kindergarten/Elementary/Secondary) Elementary

Date Nature of Abuse Victims Perpetrators Relationship Action Status

of Incident to the Taken (Resolved/Pending/
Referred to other
Victim agency)
Physical Sexual Verbal/Psychol Name Age Sex Name Age Sex
ogical (Last Name, M/F (Last M/F
First Name,
Name,MI First
Name,MI
NONE

Note: Bullying is perpetrated by a student against another student which may be:
 Physical- unwanted physical contact (punching,shoving,pushing,kicking,slaping,tickling,headlocks etc.
 Social-refers to any deliberate, repetitive and aggressive social behavior intended to hurt or belittle an individual(name calling,cursing,labellng,etc.
 Gender- Based-refers to any act that humiliates or exclude a persons on the basis of perceived or actual sexual orientation and gender identity
 Cyber Bullying-any bullying done through the use of technology or any electronic means (texting,email,chatting,online games etc.)

Prepared by:
ELMER G. TORADO
School Guidance Coordinator

Date: June 29, 2015

Reviewed and Conformed by:

ZENAIDA A. CAUSING
Principal I

Date: June 29, 2015