Annex B.
Form 1 – Classroom Level
NATIONAL SCHOOL DEWORMING DAY
Region: Division: District: 2
School ID: Name of School:
Enrolment: Grade level & Section:
Enrolment Dewormed Remarks
NAME OF CHILD Actions Taken
Hand- Feeding Tooth-
Non- Non- washing brushing
4P’s 4P’s 4P’s 4P’s
Accomplished by: Noted by:
Class Adviser Health Coordinator
Date Accomplished:
Form 2 – School Level Annex B.2
NATIONAL SCHOOL DEWORMING DAY
Region: VII Division: Bais DepEd
School ID: 323012
Name of School: MAYOR PRAXEDES P. VILLANUEVA II MHS
NO. OF CHILDREN
ENROLMENT DEWORMED
GRADE LEVEL Non- REMARKS
4P’s Non-4P’s 4P’s 4P’s
Grade 7- Prudence 11 21 4 7 Health teaching done
& Monitored
Grade 7- Justice 13 17 5 10 same
Grade 7-Temperance 8 26 6 11 same
Grade 8- Hope 25 16 same
Grade 8- Fortitude 12 12 9 8 same
Grade 9- Modesty 19 33 11 14 same
Grade 10- Charity 14 33 8 19 same
TOTAL 77 167 43 85
Accomplished by: Noted by:
School Head
Prepared by:
School Health Coordinator
Date Accomplished: