(Enclosure No. 1A to DepEd Memorandum No. 39, s.

2015)

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

SCHOOL - BASED REPORTS ON INCIDENTS OF BULLYING

School Year : 2016 - 2017

School: BULASA ELEMENTARY SCHOOL Classification (Public / Private): Public

Address: Bulasa,Argao, Cebu Level (Kindergarten, Elementary, Secondary): Elementary

Nature of Bullying Victims Perpetrator Status

Date / Place of Action (Resolved/Pending
Recommendation /Refrred to Other
Incident Gender - Cyber Retaliation Sex Sex Taken
Physical Social Name Age Name Age
Based Bullying (M / F) (M / F) Agency)

Note: Bullying is perpetrated by a student against another student which may be:
Physical - unwanted Physical contact (punching, shoving, kicking, pushing, slapping, headlocks, etc.)
Social - refers to any deliberate, repetitive and aggressive social behavior intended to hurt or belittle an indiviual ( name - calling, cursing, labelling, etc.)
Gender- Based - refers to any act that humiliates or excludes a person 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.)

Reviewed and Conformed by: Prepared by:

Name and Designation Name and Designation
Date: ________________________________ Date: _________________________________
(Enclosure No. 1B to DepEd Memorandum No. 39, s. 2015)

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

SCHOOL - BASED REPORTS ON INCIDENTS OF CHILD ABUSE

School Year : 2016 - 2017

School: BULASA ELEMENTARY SCHOOL Classification (Public / Private): Public

Address: Bulasa,Argao, Cebu Level (Kindergarten, Elementary, Secondary): Elementary

Nature of Abuse Victims Perpetrators

Status
Date / Place of Name Name Relationship to (Resolved/Pending/Re
Verbal / Sex Sex Action Taken
Incident Physical Sexual ( Last Name, First Age ( Last Name, First Age the Victim frred to Other
Psychological (M / F) (M / F) Agency)
Name, M.I.) Name, M.I.)

Note: Bullying is perpetrated by a student against another student which may be:
Physical - refers to the act that inflicst bodily harm and which subjects children to perform tasks which are hazardous to their physical - being
Sexual- refers to acts that are sexual in nature such as rape, sexual harrassment, sexually demeaning remarks, forcing children to watch obscene publications or shows, etc; and
Psychological - refers to acts or ommissions causing likely to cause mental or emotional sufferring to the child which include intimidation, harrassment, stalking, public ridicule,
threat, or deduction from grade or merit as a form of punishment, and replealed verbal abuse.

Relationship to the victim refers to relatives (Father, Mother, cousin, etc.) or school personnel (teachers and non-teaching staff)
No amicable sttlements for any acts of child abuse

Reviewed and Conformed by: Prepared by:

Name and Designation Name and Designation
Date: ________________________________ Date: _________________________________
(Enclosure No. 2A DepEd Memorandum No. 59, s. 2015)
(To be submitted to the Regional Office on or before June 30)
Division Consolidated Report on Incidents of Bullying
School Year: 2016 - 2017
Division: CEBU PROVINCE

Total Number of Public School: ____________ Total Number of Private Schools: _____________
Elementary: ____________ Elementary: __________
Secondary: ____________ Secondary: __________
Total: ____________ Total: __________

Nature of Bullying No. of Bullying Incidents

School
Total No. of Male Total No. of Female
Physical Social Gender-Based Cyber Bullying Retaliation Total
Victims Victims

I. Public
A. Elementary
1.
2.

Sub-total
B. Secondary
1.
2.

Sub-total

II. Private
A. Kindergarten
1.

Sub-total

B. Elementary
1.
2.

Sub-total

C. Secondary
1.
2.

Sub-total

Total

Note: Bullying is perpetrated by a student against another student which may be:
* Physical - unwanted physical contact (punching, shoving, pushing, kicking, slapping, tickling, headlocks, etc.)

* Social - refers to any deliberate, repititive and aggressive social behavior intended to hurt or belittle an individual (name-calling, cursing, labelling, etc.)

* Gender-based - refers to any act that humiliates or excludes a person on the basis of perceived or actual sexua 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:

Name and Designation

Date
Reviewed and Confirmed by:

School Head / TIC

Date
(Enclosure No. 2A DepEd Memorandum No. 59, s. 2015)
(To be submitted to the Regional Office on or before June 30)
Division Consolidated Report on Incidents of Child Abuse
School Year: 2016 - 2017
Division: CEBU PROVINCE

Total Number of Public School: ____________ Total Number of Private Schools: _____________
Elementary: ____________ Elementary: __________
Secondary: ____________ Secondary: __________
Total: ____________ Total: __________

Nature of Abuse No. of Incidents of Child Abuse

School Perpetrators
Verbal/ Total No. of Total No. of
Physical Social Total
Psychological Male Victims Female Victims
Relatives School Personnel

I. Public
A. Elementary
1.
2.

Sub-total
B. Secondary
1.
2.

Sub-total

II. Private
A. Kindergarten
1.

Sub-total

B. Elementary
1.
2.

Sub-total

C. Secondary
1.
2.

Sub-total

Total

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 body 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 obsence
publications or shows etc.; and

* Psychological - refers to acts omissions causng or likely to cause mental or emotional suffering to the child which include intimidation, harassment,
statuing, public ridicule, threat of deduction from grade or merit as a form of punishment, and repeated verbal abuse.

* Cyber Bullying - any bullying done through the use of technology or any electronic means (texting, email, chatting, online games, etc.)

* 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 schild abuse

Reviewed and Confirmed by: Prepared by:

School Head / TIC Name and Designation

_________________________ __________________
Date Date
 CONSOLIDATED REPORT ON CASES OF CHILDREN - AT - RISK (CAR)

School/Division/Region:

Period Covered:

I. CHILDREN - AT - RISK

Classification No. of Students Action Taken Remarks

Male Female

1. Victim of abuse (sexual, physical, psychological, mental,

economic, and other mean)

2. Victim of neglect
3. Coming froma dysfucntional family or without parent or
guardian

4. Being member of a gang

5. Living in a community with a higher level of criminality

6. Living in a situation of armed conflict
7. Committed a status Offense under Section 57 of RA
9344, as amended
8. Prostituted children

9. Medicant under PD 1563

10. Solvent/Rugby User

11. Others

II. Description of action taken by the school or division to alleviate the risk factors of the CAR:

Prepared by: Noted by:

Designation Principal/Superintendent/Regional Director