Académique Documents
Professionnel Documents
Culture Documents
VICTIMS RESPONDENTS
NAME AGE SEX NAME AGE SEX NATURE OF ACTION/S RECOMMENDATIONS
(M or F) (M or F) COMPLAINT TAKEN
Annex “B”
DEPARTMENT OF EDUCATION
INTAKE SHEET
I. INFORMATION
•VICTIM
Name : ______________________________________________________
Date of Birth: ____________________________________Age: _______________ Sex:___________
Grade/Yr. and Section: __________________________________ Adviser: _______________________
Parents:
Mother: __________________________________________ Age: ________________
Occupation: ____________________________________
Address: ______________________________________________________
Father: ____________________________________________ Age: ___________________
Occupation: ____________________________________
Address and Contact Number :_______________________________________________________
•COMPLAINANT
Name: ___________________________________________________________________
Relationship to the Victim: _____________________________________________
Address and Contact Number : ___________________________________________
•RESPONDENT
C.1. If a respondent is a School Personnel
Annex “B”
Name : ______________________________________________________
Date of Birth : ____________________________ Age: __________ Sex: ____________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
________________________________________________________
Annex “B”
III. ACTION TAKEN:
1.
2.
3.
4.
5.
IV. RECOMMENDATIONS:
1.
2.
3.
4.
5.
Prepared by:
______________________________________
Name over Printed Name
______________________________________
Designation
________________________________________
Date
Annex “C”
DEPARTMENT OF EDUCATION
Child Protection Policy Template
Objective
School Head/
Principal
Referral System Monitoring System
Consolidate reports on
incidents and cases of all
For possible filling Other schools ans submit a
of criminal action
Division
assistance Division Report (Annex
Office “A” to the Regional Office
*assessment NGO and
*psycho-social intervention other Consolidate reports on
PNP ( *protective measures government incidents and cases of all
Women offices Regional schools ans submit a
and Division Report (Annex
Office “A” to the Undersecretary
Children
for Legal and Legislative
Protection Affairs
Desk)
Central repository of
DSWD (Regional Central Regional Reports
LSWDO Office Crisis Office (Annex “A”)
Intervention Unit)
THANK YOU!!!