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: