Form 2A School Level

Republic of the Philippines

Department of Education
Region XII
Division of Sultan Kudarat
_____________District
NAME OF SCHOOL

NATIONAL SCHOOL DEWORMING ACCOMPLISHMENT REPORT

DATE OF DEWORMING: _______________________

GRADE ENROLMENT NO. OF LEARNERS DEWORMED NO. OF LEARNERS

NOT DEWORMED
LEVEL DUE TO

Consent not

Medical Condition
Sickness / Serious

(Specify)
4Ps Non-4Ps TOTAL 4Ps Non-4Ps TOTAL

returned

Refusal

Others
Parent
M F TOTAL M F TOTAL M F TOTAL M F TOTAL M F TOTAL M F TOTAL

KINDER
GRADE 1
GRADE 2
GRADE 3
GRADE 4
GRADE 5
GRADE 6
TOTAL

Accomplished by: Noted by:

______________________________ ________________________
Clinic Teacher School Head

Date Accomplished: _____________

Form 2A School
Republic of the Philippines
Department of Education
Region XII
Division of Sultan Kudarat
_____________District
NAME OF SCHOOL

NATIONAL SCHOOL DEWORMING ACCOMPLISHMENT REPORT

DATE OF DEWORMING: _______________________

GRADE ENROLMENT NO. OF LEARNERS DEWORMED NO. OF LEARNERS

NOT DEWORMED
LEVEL 4Ps Non-4Ps TOTAL 4Ps Non-4Ps TOTAL

(Specify
returned
Consent

Refusal

Others
Parent
Sickness /

Condition
Medical
Serious
not

)
M F TOTAL M F TOTAL M F TOTAL M F TOTAL M F TOTAL M F TOTAL
GRADE 7 0 0 0 0 0 0 0 0 0 0
GRADE 8 0 0 0 0 0 0 0 0 0 0
GRADE 9 0 0 0 0 0 0 0 0 0 0
GRADE 10 0 0 0 0 0 0 0 0 0 0
GRADE 11 0 0 0 0 0 0 0 0 0 0
GRADE 12 0 0 0 0 0 0 0 0 0 0
TOTAL 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Accomplished by: Noted by:

______________________________ ________________________
Clinic Teacher School Head

Date Accomplished: _____________