Revised based on the Enclosure No. 2A to DepEd Memorandum No.59, s.

2015 as of Aug 2022

(To be submitted to the Regional Office on or before June 30)

Division Consolidated Report on Incidents of Bullying

School Year 20____ - 20____
Division:
Total Number of Public Schools: Total Number of Private Schools:
Kindergarten: Kindergarten:
Elementary: Elementary:
Junior High School: Junior High School:
Senior High School: Senior High School:
Total: Total:

Nature of Bullying No. of Bullying Incidents

School Physical Social Gender-Based Cyber Bullying Retaliation Total no. Total no. Action Taken Remarks
of Male of Female Total
M F M F M F M F M F Victims Victims

I. Public
A. Elementary
1
2
Sub-Total

B. Secondary
1
2
Sub-Total

II. Private
A. Kindergarten
1
2
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, repetitive and aggressive social behavior intended to hurt or belittle an individual (name-calling, curisng, 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.)

Prepared by: Validated by:

(Name and Designation) (Name and Designation)

Date: Date:
(Enclosure No. 1A to DepEd Memorandum No.59, s.2015)
(To be submitted to the Division Office a week after the start of each school year)

School-Based Report on Incidents of Bullying

School Year 20____ - 20____

School: Classification: (Private/Public) School ID:

Address: Level: (Kindergarten/Elementary/Secondary)

Nature of Bullying Victims Perpetrator Status

Date/ Place
Gender- Cyber Sex Sex Action Taken Recommendation (Resolved/ Pending/
of Incident Physical Social Retaliation Name Age Name Age
based Bullying (M/F) (M/F) Referred to other agency)

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, repetitive and aggressive social behavior intended to hurt or belittle an individual (name-calling, curisng, 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.)

Revised and Conformed by: Prepared by:

(Name and Designation) (Name and Designation)

Date: Date:
Revised based on the Enclosure No. 3B to DepEd Memorandum No.59, s.2015 as of August 2022

Regional Consolidated Report on Incidents of Child Abuse

School Year 20____ - 20____
Legend: M Male

F Female

Region:

Total Number of Public Schools: Total Number of Private Schools:

Kindergarten: Kindergarten:
Elementary: Elementary:
Junior High School: Junior High School:
Senior High School: Senior High School:
Total: Total:

I. Public School
Kindergarten Elementary Junior High School Senior High School No. of Abuse Inidents
Nature of Abuse Nature of Abuse Nature of Abuse Nature of Abuse
Total
Division Verbal Verbal Verbal Verbal Total
Physical Sexual Perpetrator Physical Sexual Perpetrator Physical Sexual Perpetrator Physical Sexual Perpetrator Number of
Psychological Psychological Psychological Psychological Number of TOTAL
Female
Male Victims
Victims
M F M F M F R SP M F M F M F R SP M F M F M F R SP M F M F M F R SP

Total

II. Private School

Kindergarten Elementary Junior High School Senior High School No. of Abuse Inidents
Nature of Abuse Nature of Abuse Nature of Abuse Nature of Abuse
Total
Division Verbal Verbal Verbal Verbal Total
Physical Sexual Perpetrator Physical Sexual Perpetrator Physical Sexual Perpetrator Physical Sexual Perpetrator Number of
Psychological Psychological Psychological Psychological Number of TOTAL
Female
Male Victims
Victims
M F M F M F R SP M F M F M F R SP M F M F M F R SP M F M F M F R SP

Total
 Common Actions Taken (Note: Please use other sheets if needed)

General intervention mechanism implemented.

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 bodily harm and which subjects children to perform tasks which are hazardous to their physical well-being.
Sexual - refer to acts that are sexual in nature such as rape, sexual harassment, sexually demeaning remarks, forcing children to watch obscene publications or shows, etc; and
Psychological - refers to acts or omissions causing or likely to cause mental or emotional suffering to the child which include intimidation harassment, stalking, public ridicule, threat of deduction from grade or
merit as a form of punishment, and repeated verbal abuse.
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 child abuse

Prepared by: (Name) Validated by: (Name)

(Designation) (Designation)

Date: Date:
Revised based on the Enclosure No. 2B to DepEd Memorandum No.59, s.2015 as of Aug 2022
(To be submitted to the Regional Office on or before June 30)
Division Consolidated Report on Incidents of Child Abuse
School Year 20____ - 20____
Division:
Total Number of Public Schools: Total Number of Private Schools:
Kindergarten: Kindergarten:
Elementary: Elementary:
Junior High School: Junior High School:
Senior High School: Senior High School:
Total: Total:

Nature of Abuse No. of Abuse Incidents

Verbal/
School Physical Sexual Psychological
Total No. Total No.
Perpetrators Action Taken Remarks
of Male of Female Total
Victims Victims School
M F M F M F Relatives Personnel
I. Public
A. Elementary
1
2
Sub-Total
B. Secondary
1
2
Sub-Total
II. Private
A. Kindergarten
1
2
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 bodily harm and which subjects children to perform tasks which are hazardous to their physical well-being.
Sexual - refer to acts that are sexual in nature such as rape, sexual harassment, sexually demeaning remarks, forcing children to watch obscene publications or shows, etc; and
Psychological - refers to acts or omissions causing or likely to cause mental or emotional suffering to the child which include intimidation harassment, stalking, public ridicule, threat of
deduction from grade or merit as a form of punishment, and repeated verbal abuse.
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 child abuse

Prepared by: Validated by:

(Name and Designation) (Name and Designation)

Date: Date:
(Enclosure No. 1B to DepEd Memorandum No.59, s.2015)
(To be submitted to the Division Office a week after the start of each school year)

School-Based Report on Incidents of Child Abuse

School Year 2021-2022

District: Mandaon North District Classification: Public School ID:

Address: Cabitan, Mandaon, Masbate Level: (Kindergarten/Elementary/Secondary)

Nature of Abuse Victims Perpetrators Status

Date of Relationship to
Verbal/ Name Sex Name Sex Action Taken (Resolved/ Pending/
Incident Physical Sexual Age Age the Victim
Psychological (Last Name, First Name, M.I.) (M/F) (Last Name, First Name, M.I.) (M/F) Referred to other agency)

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 bodily harm and which subjects children to perform tasks which are hazardous to their physical well-being.
Sexual - refer to acts that are sexual in nature such as rape, sexual harassment, sexually demeaning remarks, forcing children to watch obscene publications or shows, etc; and
Psychological - refers to acts or omissions causing or likely to cause mental or emotional suffering to the child which include intimidation harassment, stalking, public ridicule, threat of deduction from grade or merit as a form of punishment, and repeated verbal abuse.
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 child abuse

Revised and Conformed by: Prepared by:

(Name and Designation) (Name and Designation)

Date: Date:
 Regional Consolidated Report on Incident Cases of Children-at-Risk (CAR)
School Year 20____ - 20____
Legend: M Male

Region: F Female

I. Total Number of Public Schools: Total Number of Private Schools:

Kindergarten: Kindergarten:
Elementary: Elementary:
Junior High School: Junior High School:
Senior High School: Senior High School:
Total: Total:

I. Public School

Classification No. of Incidents of Abuse

Victims of
Abuse (sexual, Coming from a Living in a Committed a
physical, Dysfunctional Being a Community Living in a status Offense Marijuana/ Total
Victims of Mendicant Solvent or Total
Division psychological, family or member of a with a Higher situation of under Section Drug Use/ Smoking Number
Neglect under PD 1563 Rugby User Number
mental, without parent gang Level of armed conflict 57 of RA 9344, Dependency of TOTAL
of Male
economic and or guardian Criminality as amended Female
Victims
other means) Victims

M F M F M F M F M F M F M F M F M F M F M F
II. Private School

Classification No. of Incidents of Abuse

Victims of
Abuse (sexual, Coming from a Living in a Committed a
physical, Dysfunctional Being a Community Living in a status Offense Marijuana/ Total
Victims of Mendicant Solvent or Total
Division psychological, family or member of a with a Higher situation of under Section Drug Use/ Smoking Number
Neglect under PD 1563 Rugby User Number
mental, without parent gang Level of armed conflict 57 of RA 9344, Dependency of TOTAL
of Male
economic and or guardian Criminality as amended Female
Victims
other means) Victims

M F M F M F M F M F M F M F M F M F M F M F

Common Actions Taken (Note: Please use other sheets if needed)

5
General intervention mechanism implemented.
Note: Please use another sheet for Common Actions Taken if needed.

Prepared by: (Name) Validted by: (Name)

(Designation) (Designation)

Date: Date:
 DIVISION CONSOLIDATED REPORT ON CASES OF CHILDREN-AT-RISK (CAR)

Division:
Period Covered:

Total Number of Public Schools: Total Number of Private Schools:

Kindergarten: Kindergarten:
Elementary: Elementary:
Junior High School: Junior High School:
Senior High School: Senior High School:
Total: Total:

I. CHILDREN-AT-RISK (CAR)

No. of Students
Classification Action Taken Remarks
Male Female

1. Victim of abuse (sexual,

physical, psychological, mental,
economic and other mean)

2. Victim of Neglect

3. Coming from a dysfunctional

family or without parent or
guardian

4. Being a member of a gang

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

6. Living a situation of armed

conflict

7. Committed a status Offense

under Section 57 of RA 9344, as
amended

8. Mendicant under PD 1563

9. Solvent/ Rugby user
10. Marijuana/ Drug Use/
Dependency
11. Smoking
12. Others

II. Descriptions of actions taken by the division to alleviate the risk factors of the CAR:

Prepared by: Validated by:

(Designation) Principal/ Superitendent/ Regional Director

Date: Date:
 Regional Consolidated Report on Other Child Protection Concerns
School Year 20____ - 20____
Legend: M Male

Region: F Female

Total Number of Public Schools: Total Number of Private Schools:

Kindergarten: Kindergarten:
Elementary: Elementary:
Junior High School: Junior High School:
Senior High School: Senior High School:
Total: Total:

I. Public School

No. of Incidents on Other Child

Classification
Protection Concerns
Division Online Sexual Sexual Other Acts of
Corporal
Child Labor Child Trafficking Exploitation of Exploitation of Abuse (Learner-to- Total Number of Total Number of
Punishment TOTAL
Children Children Leaner) Male Victims Female Victims
M F M F M F M F M F M F
II. Private School

No. of Incidents on Other Child

Classification
Protection Concerns

Division Online Sexual Sexual Other Acts of

Corporal
Child Labor Child Trafficking Exploitation of Exploitation of Abuse (Learner-to- Total Number of Total Number of
Punishment TOTAL
Children Children Leaner) Male Victims Female Victims
M F M F M F M F M F M F

Common Actions Taken (Note: Please use other sheets if needed)

Prepared by: (Name) Validated by: (Name)

(Designation) (Designation)

Date: Date:
 Division Consolidated Report on Other Incident on Child Protection
School Year 20____ - 20____

Division:

Total Number of Public Schools: Total Number of Private Schools:

Kindergarten: Kindergarten:
Elementary: Elementary:
Junior High School: Junior High School:
Senior High School: Senior High School:
Total: Total:

No. of Incidents on Other

Classification
Child Protection Concerns
Schools Online Sexual Sexual Other Acts of Total Total ACTION TAKEN REMARKS
Corporal
Child Labor Child Trafficking Exploitation of Exploitation of Abuse (Learner-to- Number of Number of
Punishment TOTAL
Children Children Leaner) Male Female
M F M F M F M F M F M F Victims Victims

I. Public

A. Elementary

Subtotal

B. Secondary

Subtotal

II. Private

A. Kindergarten

Subtotal

B. Elementary

Subtotal

C. Secondary

Subtotal

Prepared by: (Name) Validated by: (Name)

(Designation) (Designation)

Date: Date:
 CONSOLIDATED REPORT ON OTHER CHILD PROTECTION CONCERNS

Division: ___________________________________________
Period Covered: ___________________________________________

Total Number of Public Schools: Total Number of Private Schools:

Kindergarten: Kindergarten:
Elementary: Elementary:
Junior High School: Junior High School:
Senior High School: Senior High School:
Total: Total:

I. Other Child Protection Concerns

No. of Students
Classification Action Taken Remarks
Male Female
Child Labor
Child Traffiking
Online Sexual Exploitation of
Children
Sexual Exploitation of Children
Corporal Punishment
Other Acts of Abuse (Learner-to-
Leaner)

II. Description of action taken by the school or division to alleviate the risk factors of the Other
Child Protection Concerns:

Prepared by: Validated by:

(Designation) Principal/ Superitendent/ Regional Director

 Appendix F
Division Consolidated Report on Incidents of Children in Conflict with the Law (CICL)
School Year 20___-20___
Division: ___________________________________________
Period Covered: ___________________________________________

A. Consolidated Report on Incidents of Children in Conflict with the Law (CICL)

Learner's Reference Sex Intervention/
Age Case/Violation Action Taken Remarks
Number (LRN) (M/F) Diversion Program

B. Description of any intervention program or diversion program that the school or division initiated or adopted whch facilitated the
reintegration of the CICL in the school and community

Prepared by: Validated by:

(Designation) Principal/ Superitendent/ Regional Director

 Regional Consolidated Report on Incidents of Children in Conflict with the Law (CICL)
School Year 20____ - 20____

Legend: M Male
Region: F Female

Total Number of Public Schools: Total Number of Private Schools:

Kindergarten: Kindergarten:
Elementary: Elementary:
Junior High School: Junior High School:
Senior High School: Senior High School:
Total: Total:

I. Public School
Level No of Incidents
Junior High Senior High Total Total
Division Elementary Total Case/Violation Common Intervention Program
School School Number of Number of
Male Female
M F M F M F
II. Private School
Level No of Incidents
Junior High Senior High Total Total
Division Elementary Total Case/Violation Common Intervention Program
School School Number of Number of
Male Female
M F M F M F

Prepared by: (Name) Validated by: (Name)

(Designation) (Designation)

Date: Date: