Annex B.

Form 1 Classroom Level

NATIONAL SCHOOL DEWORMING DAY

Region: ______________ Division: ________________________ District:

________________________________
School ID: ______________________ Name of School:
___________________________________________________
Enrolment: _____________________ Grade level & Section:
_______________________________________________

Enrolme Deworm Remarks

NAME OF CHILD nt ed Actions
Hand- Feedi Tooth-
washi ng brushi Taken
ng ng
No No
4P n- 4P n-
s 4P s 4P
s s
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.

Accomplished by: Noted by:

_____________________________________ _______________________________________
 Class Adviser Clinic Teacher
Date Accomplished: ____________________

Form 2 School Level Annex B.2

NATIONAL SCHOOL DEWORMING DAY

Region: ______________ Division: ________________________ District:

______________________________
School ID: ________________________________________________________
Name of School: ___________________________________________________

NO. OF CHILDREN
ENROLMENT DEWORMED
GRADE LEVEL Non- REMARKS
4Ps Non- 4Ps 4Ps
4Ps
KINDER
GRADE I
GRADE II
GRADE III
GRADE IV
GRADE V
GRADE VI
TOTAL

Accomplished by: Noted by:

_________________________________ ___________________________________
School Principal District Supervisor

Date Accomplished: ____________________________