Barangay Data Capture Form: Monitoring of Incidence On Violence Against Women (Vaw) During The Covid-19 Pandemic
Barangay Data Capture Form: Monitoring of Incidence On Violence Against Women (Vaw) During The Covid-19 Pandemic
Barangay Data Capture Form: Monitoring of Incidence On Violence Against Women (Vaw) During The Covid-19 Pandemic
Region:___________________
Province:______________________________________
City/Municipality:_______________________________
Barangay:____________________________________
Psychologi
Referred for
VAW Physical Sexual cal/ Economic Referred to Referred to Referred to
Issued BPO Medical
VICTIM/S Abuse Abuse Emotional Abuse LSWDO PNP NBI
(3a) Treatment
(1) (2a) (2b) Abuse (2d) (3b) (3c) (3d)
(3e)
(2c)
Victim 1
Victim 2
Victim 3
TOTAL
Others
Referred for (ex:
Referred to
Legal Referred to
Court
Assistance NGOs,
(3g)
(3f) FBOs)
(3h)
Region:___________________
Province:______________________________________
City/Municipality:_______________________________
Barangay:____________________________________
Psychologi
VAC Immediate
AGE Physical Sexual cal/ Other Close
VICTIM/S Male Female Neglect Family
(3) Abuse Abuse Emotional Relative
(1) (2a) (2b) (4d) Member
(4a) (4b) Abuse (5b)
(5a)
(4c)
Child 1
Child 2
Child 3
TOTAL
*If ✔, encode "1" on the applicable fields *Immediate Family Member/s – parents and sibling
*If "Others," please specify *Other Close Relative/s – uncles, aunts, grandpare
NGAY DATA CAPTURE FORM
CE AGAINST CHILDREN (VAC) DURING THE COVID-19 PANDEMIC
e period: May 16, 2020- June 15, 2020
✔=1 ✔=1 ✔=1 ✔=1 pls. specify ✔=1 ✔=1 ✔=1 ✔=1 ✔=1
Others
(ex:
Referred to
NGOs,
FBOs)
(6f)
pls. specify