OPLAN KALUSUGAN SA DEPED ACTIVITY ACCOMPLISHMENT FORM

NAME OF SCHOOL: ___________________________________________________________________

SCHOOL HEAD: _______________________________________
DATE CONDUCTED: ____________________________________

SUMMARY OF BENEFICIARIES COVERED: MEDICAL, DENTAL & NURSING SERVICE

Activity conducted: __________________________________________

(Example: Dental Mission and Medical Mission)

Number of students covered by DepEd and Volunteers

Grade / Year Level Actual Actual Number Actual Number
Number Treated Referred
Examined
Kinder
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Total: Elementary

Grade 7
Grade 8
Grade 9
Grade 10
Grade 11
Grade 12
Total: High School

SUMMARY OF VOLUNTEER SERVICES

Number of Partners Involved

Number of Number of Pupils Number of School Personnel/
Name of Organization Volunteers Teachers
Involved Examined Treated Examined Treated

Type of Donations Estimated Cost

1
SIGNIFICANT EVENTS OF SBFP, NDEP, ARH, WINS, AND OTHER HEALTH AND NUTRITION
PROGRAMS / EXPERIENCES /GOOD PRACTICES (Use separate sheets, if needed)
NDEP (National Drug Education Program)
Activity title:
Participants: Please include specific number)
Partner Agency:
Person Responsible:

ARH (Adolescent Reproductive Health)

Activity title:
Participants:
No. of Participants:
Partner Agency:
Person Responsible:

WINS (Water, Health and Sanitation in Schools)

Activity title:
Participants:
No. of Participants:
Partner Agency:
Person Responsible:

Other Health Related Programs

(Example: Mental Health Awareness/ Disaster Awareness/Stress Management Seminar for
Teachers)

LESSONS LEARNED SUGGESTIONS TO STRENGTHEN

OK sa DepEd Program

2
I. PHOTOS (before, during and after)

Prepared by: Date:

Name and Designation