Government Elementary School Profile, Sy 2020-2021: Status Div. In-Charge

GOVERNMENT ELEMENTARY SCHOOL PROFILE, SY 2020-2021 STATUS DIV.
IN-CHARGE
Difference Validated by:
TABLE BOX Page # TITLE between last (Division
SY Coordinator/Personnel)
1 SCHOOL INFORMATION Revised PRS SGOD & SDO

1 2 Table 1. LEARNERS BY PROGRAM, SY 2020-2021 (As of October 31, 2020) Revised PRS SGOD
2 2 Table 2. LEARNERS WITH DISABILITIES (LWDs) UNDER THE HOMEBOUND AND HOSPITAL BOUND PROGRAM, SY 2020-2021 (As of October 31, 2020) Revised SPED
3 (Continuation from previous page, Table 2) SPED
3 4 Table 3. NUMBER OF FUNCTIONAL ASSISTIVE TECHNOLOGY AND ADAPTIVE DEVICES FOR LWDs, SY 2020-2021 (As of October 31, 2020) Revised SPED
4 5 Table 4. NUMBER OF FUNCTIONAL EQUIPMENT AND TOOLS FOR LWDs, SY 2020-2021 (As of October 31, 2020) Revised SPED
5 6 Table 5. LEARNING RESOURCES NEEDED FOR THE LEARNERS WITH DISABILITIES (LWDs), SY 2020-2021 (As of October 31, 2020) Revised SPED
6 7 Table 6. TEACHERS HANDLING LEARNERS WITH DISABILITIES (LWDs) (Nationally-funded teachers only), SY 2020-2021 (As of October 31, 2020) Revised SPED & HR
7 8 Table 7. LOCALLY-FUNDED TEACHERS WORKING IN THE SCHOOL BY FUNDING SOURCE, SY 2020-2021 (As of October 31, 2020) Revised HR
8 8 Table 8. LOCALLY-FUNDED TEACHERS WORKING IN THE SCHOOL WHO ARE QUALIFIED AND TRAINED, SY 2020-2021 (As of October 31, 2020) Revised HR / HRTD
Table 9. DEPARTMENT OF EDUCATION (DepEd) SUBSIDIZED CONTRACT OF SERVICE (COS) TEACHERS/ASATIDZ HANDLING ALIVE CLASSES,
9 8 Revised HR / DAC
SY 2020-2021 (As of October 31, 2020)
10 9 Table 10. TEACHING RELATED AND NON-TEACHING PERSONNEL (Nationally-funded), SY 2020-2021 (As of October 31, 2020) Revised HR
11 10 Table 11. TEACHING PERSONNEL (Nationally-funded), SY 2020-2021 (As of October 31, 2020) Revised HR
12 11 Table 12. TEACHER ASSIGNMENTS (Nationally-funded teachers working in the school), SY 2020-2021 (As of October 31, 2020) Revised HR
Table 13. TEACHERS WHO RECEIVED TRAINING WHILE IN-SERVICE FROM JULY 2019 TO JUNE 2020
13 11 Revised HR / HRTD
(Nationally-funded teachers working in the school), SY 2020-2021 (As of October 31, 2020)
Table 14. TEACHERS WHO RECEIVED TRAINING ON INFORMATION AND COMMUNICATIONS TECHNOLOGY (ICT)
14 12 Revised HRTD
(Nationally-funded teachers actually working in the school), SY 2020-2021 (As of October 31, 2020)
Table 15. TEACHERS WHO RECEIVED TRAINING ON PEDAGOGY
15 12 Revised HRTD
16 13 Table 16. NUMBER OF TEACHERS BY GRADE LEVEL (Nationally-funded teachers actually working in the school), SY 2020-2021 (As of October 31, 2020) Revised HR
Table 17. NUMBER OF TEACHERS BY TEACHING ASSIGNMENT IN GRADES 4 TO 6
17 13 Revised HR
18 14 Table 18. NUMBER OF TEACHERS BY HIGHEST EDUCATIONAL ATTAINMENT (Nationally-funded teachers only), SY 2019-2020 (As of October 31, 2020) Revised HR
1 14 Box 1. LEARNING ACTION CELL (LAC) SESSIONS, SY 2020-2021 (As of October 31, 2020) Revised CID
2 14 Box 2. ACTION RESEARCH, SY 2020-2021 (As of October 31, 2020) Revised SEPS_PRS SGOD
3 15 Box 3. SCHOOL GOVERNMENT PROGRAM (SGP), SY 2020-2021 (As of October 31, 2020) Revised YFD
4 15 Box 4. SUPREME PUPILS GOVERNMENT (SPG) ACTIVITIES, SY 2020-2021 (As of October 31, 2020) Revised YFD
5 15 Box 5. CAREER GUIDANCE PROGRAM, SY 2020-2021 (As of October 31, 2020) Revised YFD
19 16 Table 19. NUMBER OF FUNCTIONAL COMPUTERS IN THE SCHOOL BY FUNDING SOURCE, SY 2020-2021 (As of October 31, 2020) Revised ITO
20 17 Table 20. NUMBER OF FUNCTIONAL ICT EQUIPMENT IN THE SCHOOL BY FUNDING SOURCE, SY 2020-2021 (As of October 31, 2020) Revised ITO
6 18 Box 6. INTERNET CONNECTIVITY, SY 2020-2021 (As of October 31, 2020) Revised ITO
21 18 Table 21. AVERAGE MONTHLY EXPENSE (IN PESOS) OF INTERNET CONNECTION BY FUNDING SOURCE, SY 2020-2021 (As of October 31, 2020) Revised ITO
22 19 Table 22. MOOE ALLOCATION, UTILIZATION AND LIQUIDATION FROM JANUARY 2019 TO DECEMBER 2019 Revised Div. Accountant
7 19 Box 7. AVAILABILITY OF ELECTRICAL SUPPLY, SY 2020-2021 (As of October 31, 2020) Revised PFD/DIV ENGNR
8 20 Box 8. SCHOOL SITE, SY 2020-2021 (As of October 31, 2020) Revised PFD/DIV ENGNR
21 (Continuation of definitions from previous page, Box 8) PFD/DIV ENGNR
9 21 Box 9. SCHOOL LOCATION, SY 2020-2021 (As of October 31, 2020) Revised PFD/DIV ENGNR
23 22 Table 23. HEALTH AND NUTRITION, SY 2020-2021 Revised SCH HEALTH
A. Number of learners who were vaccinated by the Department of Health among the learners this SY 2020-2021 from August 1 to December 31, 2020
22 Revised SCH HEALTH
(based on LGU health records)
22 B. Number of learners who underwent vision screening Revised SCH HEALTH
22 C. Number of learners by nutritional status Revised SCH HEALTH
23 D. Number of learners who were dewormed from August 1 to December 31, 2020 (based on LGU health records) Revised SCH HEALTH
10 23 Box 10. SCHOOL CLINIC, SY 2020-2021 (As of December 31, 2020) Revised SCH HEALTH
11 24 Box 11. AVAILABILITY OF WATER SUPPLY, SY 2020-2021 (As of December 31, 2020) Revised SCH HEALTH
24 24 Table 24. NUMBER OF EXISTING WASH FACILITIES, SY 2020-2021 (As of December 31, 2020) Revised SCH HEALTH
25 25 Table 25. ORAL HEALTH, PREVIOUS SY 2019-2020 Revised SCH HEALTH
26 25 Table 26. MEDICAL AND NURSING SERVICES, PREVIOUS SY 2019-2020 Revised SCH HEALTH
27 25 Table 27. MENTAL HEALTH, For the months of April 2020 to November 2020 NEW SCH HEALTH
12 26 Box 12. MENTAL HEALTH, PREVIOUS SY 2019-2020 Revised SCH HEALTH
13 27 Box 13. CANCER CASES, PREVIOUS SY 2019-2020 NEW SCH HEALTH
14 28 Box 14. ADOLESCENT REPRODUCTIVE HEALTH, PREVIOUS SY 2019-2020 NEW SCH HEALTH
15 29 Box 15. TOBACCO CONTROL, SY 2020-2021 (As of December 31, 2020) Revised SCH HEALTH
16 30 Box 16. NATIONAL PREVENTIVE DRUG EDUCATION, SY 2020-2021 (As of December 31, 2020) Revised SCH HEALTH
17 30 Box 17. OK sa DepED PROGRAM, SY 2020-2021 (As of December 31, 2020) NEW SCH HEALTH
18 30 Box 18. FEEDING PROGRAM, SY 2020-2021 (As of December 31, 2020) Revised SCH HEALTH
19 30 Box 19. FOOD HANDLING, SY 2020-2021 (As of December 31, 2020) Revised SCH HEALTH
20 31 Box 20. SOLID WASTE MANAGEMENT, SY 2020-2021 (As of December 31, 2020) Revised SCH HEALTH
21 31 Box 21. OPERATION AND MAINTENANCE OF SANITATION FACILITIES, SY 2020-2021 (As of December31, 2020) Revised SCH HEALTH
22 31 Box 22. MENSTRUAL HYGIENE, SY 2020-2021 (As of December 31, 2020) Revised SCH HEALTH
23 32 Box 23. CHILD PROTECTION, PREVIOUS SY 2019-2020 NEW CHILD PROTECTION
24 32 Box 24. CHILD PROTECTION: VIOLENCE AGAINST CHILDREN, PREVIOUS SY 2019-2020 NEW CHILD PROTECTION
25 33 Box 25. CHILD PROTECTION: BULLYING, PREVIOUS SY 2019-2020 NEW CHILD PROTECTION
26 34 Box 26. SCHOOL SPORTS PROGRAM: AVAILABLE SPORTS EVENTS, CLUBS, AND FACILITIES, SY 2020-2021 (As of October 31,2020) Revised SPORTS
28 35 Table 28. SCHOOL SPORTS PROGRAM: SPORTS PERSONNEL (DepEd Funded), SY 2020-2021 (As of October 31,2020) Revised SPORTS
29 36 Table 29. DISASTERS/CALAMITIES, For the months of June 2019 to May 2020 Revised DRRM
37 (Continuation from previous page, Table 29) DRRM
30 38 Table 30. DISASTERS/CALAMITIES (Human-Induced Hazards - Armed Conflict and Grave Child Rights Violations), For the months of June 2019 to May 2020 Revised DRRM
39 (Continuation from previous page, Table 30) DRRM
31 39 Table 31. RESULT OF DISASTER INCIDENCES, For the months of June 2019 to May 2020 Revised DRRM
27 40 Box 27. ENABLING ENVIRONMENT, For the months of June 2019 to May 2020 Revised DRRM
41 (Continuation from previous page, Box 27) DRRM
28 41 Box 28. SAFE LEARNING FACILITIES, For the months of June 2019 to May 2020 Revised DRRM
29 42 Box 29. SCHOOL DISASTER MANAGEMENT, For the months of June 2019 to May 2020 Revised DRRM
42 (Continuation from previous page Box 29) DRRM
30 44 Box 30. DISASTER RISK REDUCTION IN EDUCATION, For the months of June 2019 to May 2020 Revised DRRM
32 45 Table 32. DISASTER RISK REDUCTION IN EDUCATION (DRRM, CCA, and Peacebuilding Trainings), For the months of June 2019 to May 2020 Revised DRRM
31 46 Box 31. DISASTER RISK REDUCTION IN EDUCATION (Information, Education and Communication (IEC) Materials), For the months of June 2019 to May 2020 Revised DRRM
32 47 Box 32. ARMED-CONFLICT RELATED INITIATIVES, For the months of June 2019 to May 2020 Revised DRRM
33 48 Box 33. INDIGENOUS PEOPLES EDUCATION (IPEd) PROGRAM, SY 2020-2021 (As of October 31, 2020) NEW IPEd
GESPv2021.02.23 School ID:
Republic of the Philippines

DEPARTMENT OF EDUCATION
PLANNING SERVICE
Education Management Information System Division
GOVERNMENT ELEMENTARY SCHOOL PROFILE

INSTRUCTIONS
This form shall be accomplished by the head of all government elementary schools. In the case of schools with annexes, extensions, etc., a separate school profile shall be accomplished by
every annex, extension, etc.
The head of the school shall sign the forms certifying to the correctness of the data, and shall be responsible and accountable for any inaccuracy or false data/information reported. He/She
shall submit the accomplished forms to the respective Schools Division Office (SDO).
Important: Read the definitions/instructions found at the bottom of each table before filling out the form. No item shall be left blank. Instead, "zero ( 0 )" shall be written. Shaded boxes
shall not be filled.
SCHOOL INFORMATION
SY 2020-2021
School Name : Region :

(Official Name)
Division :
School District :
(Previous Name, if any)
Legislative District :
Address : Telephone Number :

No. Street/Sitio/Purok Barangay
Mobile Number :
Fax Number :
Municipality/City Province Zip Code
Website (if any) :
E-Mail Address :
Date Established (Year) :
Check (a) if the school is: Check (a) if the school has the following Curricular Offering Classification (COC):
0 a Central School 0 Kindergarten
0 a SPED Center 0 Grades 1 to 6
0 with SPED Classes/Programs
0 an Annex/Extension School (Indicate Mother School ID: )
Certified True and Correct by: Validated by Planning Officer III (PRS-SGOD): Noted by the Schools Division Office:
School Head : Head of the Office :
(Signature Over Printed Name) (Signature Over Printed Name)
(Signature Over Printed Name)
Position Title : Position Title :
515377012.xlsx SchInfo Page 1 of 48
Table 1. LEARNERS BY PROGRAM, SY 2020-2021 (As of October 31, 2020)
TOTAL
Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6
Enrollment by Program (Kindergarten to Grade 6)
Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female
1. Madrasah Education Program (MEP):
Arabic Language and Islamic Values Education (ALIVE)
1.a. Muslim 0 0
1.b. Non-Muslim 0 0
2. Special Science Elementary School (SSES) 0 0

Notes: Enrollment by Program - refers to the number of learners according to programs offered in elementary school.
Types of Special Programs:
1. Madrasah Education Program (ALIVE) - a program which aims to preserve the Arabic language and Muslim culture through its inclusion in the regular basic education curriculum.
2. Special Science Elementary School (SSES) - a program which aims to enrich the science curriculum in public elementary school.
Table 2. LEARNERS WITH DISABILITIES (LWDs) UNDER THE HOMEBOUND AND HOSPITAL BOUND PROGRAM, SY 2020-2021 (As of October 31, 2020)
HOMEBOUND HOSPITAL BOUND
Age Profile Grade Placement Length of Time in the Program Age Profile Grade Placement Length of Time in the Program
Classification/Types of Disabilities 5-10 11-15 16-20 21-25 Kindergarten 5-10 11-15 16-20 21-25 Kindergarten
to Transition 5-10 11-15 16-20 21-25 to Transition 5-10 11-15 16-20 21-25
years years years years TOTAL TOTAL TOTAL years years years years TOTAL TOTAL TOTAL
Program years years years years Program years years years years
old old old old Grade 6 old old old old Grade 6
With Diagnosis from Licensed Medical Specialist:
1. Visual Impairment 0 0 0 0 0 0
2. Hearing Impairment 0 0 0 0 0 0
3. Learning Disability 0 0 0 0 0 0
4. Intellectual Disability 0 0 0 0 0 0
5. Autism Spectrum Disorder 0 0 0 0 0 0
6. Emotional-Behavioral Disorder 0 0 0 0 0 0
7. Orthopedic/Physical Handicap 0 0 0 0 0 0
8. Speech/Language Disorder 0 0 0 0 0 0
9. Cerebral Palsy 0 0 0 0 0 0
10. Special Health Problem/Chronic Disease 0 0 0 0 0 0
10.a. Cancer 0 0 0 0 0 0
11. Multiple Disabilities 0 0 0 0 0 0
With Manifestations:
1. Difficulty in Seeing 0 0 0
2. Difficulty in Hearing 0 0 0
3. Difficulty in Applying Knowledge 0 0 0

4. Difficulty in Remembering, Concentrating,
Paying Attention and Understanding 0 0 0
5. Difficulty in Applying Adaptive Skills 0 0 0
6. Difficulty in Displaying Inter-Personal Behavior 0 0 0
Difficulty in Mobility
7. 0 0 0
(Walking, Climbing and Grasping)
8. Difficulty in Communicating 0 0 0
TOTAL 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
(See definitions on the next page)
Reminders: 1. For 10.a., out of the total number of learners with Special Health Problems / Chronic Disease, determine the number of learners who are cancer patients, living with cancer and cancer survivor.
2. LWDs with two or more manifestations, shall be counted under dominant/prevalent manifestation/difficulty.
3. Table 2 shall be accomplished ONLY by Elementary Schools and SPED Centers with SPED classes/programs.
Certified True and Correct by: Validated by Division SPED Coordinator: Validated by Planning Officer III (PRS-SGOD):
School Head : 0
(Signature Over Printed Name) (Signature Over Printed Name) 0
Position Title : 0 Position Title :
515377012.xlsx Table1-2 Page 2 of 48

(Continuation from previous page, Table 2)
Classification of Learners with Disabilities:

1. With Diagnosis from Licensed Medical Specialist - refers to learners who have undergone assessment of licensed professionals like Psychologists, Psychmetricians, and Medical Specialists who can determine the level
of disability of any learner.
2. With Manifestations - refers to learners manifesting difficulties in particular activities (e.g., cognitive, communication, mobility, hearing, seeing, etc.) who were observed by teachers on daily lessons/activities or
through anecdotals.
Learners with Disabilities under the Homebound and Hospital Bound Program:
1. Homebound - refers to an educational program designed for children with disabilities who are enrolled in the nearest school to their residence, but can not go to school on a regular schedule. Community volunteers,
para-teacher, parents or any member of the family are trained to assist the child at home.
2. Hospital Bound - refers to an educational program designed for LWDs with severe disturbance, profound level of disability, bed-bound, with crippling, chronic or serious health disabilities/impairments and recovering
patient (LWDs).
3. Age Profile (Homebound/Hospital bound) - refers to a range of age per type of learners with disabilities.
4. Grade Placement (Homebound/Hospital bound) - refers to what program the learners are placed or enrolled.
5. Length of time (Homebound/Hospital bound) - refers to the number of years that the learner spent in the program.
6. Transition Program or Self-Contained Non-Graded - refers to the coordinated set of activities for LWDs ages 5 to 14 who are placed in a self-contained non-graded classes. It is designed within an outcome-oriented
process that promotes movement from home to school, school to functional life and school to employment/enterprenuership; including vocational training, integrated employment, continuing adult education, and
services and community participation.
LWDs With Diagnosis from Licensed Medical Specialist:

1. Visual Impairment - refers to a learner with an impairment that even with correction, adversely affects a child's educational performance. This includes both partial sight and blindness.
2. Hearing Impairment - refers to a learner with an impairment, whether permanent or fluctuating that adversely affects a child’s educational performance such as deafness.
3. Learning Disability - refers to a learner with a disorder in perception, listening, thinking, reading, writing, spelling, and arithmetic although normal in sensory, emotional and intellectual abilities.
4. Intellectual Disability - refers to a learner with significantly subaverage general intellectual functioning which originates during the developmental period and associated with impairment in adoptive behavior like
maturation, learning and social adjustment.
5. Autism Spectrum Disorder - refers to a learner characterized by varying degrees of impairment in communication skills and social interactions and in restrictive, repetitive patterns of behavior.
6. Emotional-Behavioral Disorder - refers to a learner with a condition exhibiting one or more of the following characteristics over a long period of time and to a marked degree that adversely affects a child's educational
performance: (i) an inability to learn that cannot be explained by intellectual, sensory, or health factors, (ii) an inability to build or maintain satisfactory interpersonal relationships with peers and teachers, (iii)
inappropriate types of behavior or feelings under normal circumstances, (iv) a general pervasive mood of unhappiness or depression, (v) a tendency to develop physical symptoms or fears associated with personal or
school factors.
7. Orthopedic /Physical Handicap - refers to a learner with any condition that interferes with a child's ability to use his or her body.
8. Speech/Language Disorder - refers to a learner with a communication disorder, such as stuttering, impaired articulation, a language impairment, or a voice impairment, that adversely affects a child’s educational
performance.
9. Cerebral Palsy - refers to a learner that is caused by damage to developing brain either before or during birth, or in the first few years of life. The impairment depends on where in the brain the damage occurs.
10. Special Health Problem/Chronic Illness - refers to a learner with a chronic or acute health problems such as asthma, attention deficit disorder or attention deficit hyperactivity disorder, diabetes, epilepsy, a heart
condition, hemophilia, lead poisoning, leukemia, nephritis, rheumatic fever, sickle cell anemia, and Tourette syndrome; that adversely affect a child's educational performance.
10.a. Cancer - refers to a learner who are cancer patients, living with cancer and cancer survivor.
11. Multiple Disabilities - refers to a learner with a combination of disabilities that causes severe educational needs that require multiple special education programs such as mental retardation-blindness or mental
retardation-orthopedic impairment.
LWDs With Manifestations:

1. Difficulty in Seeing - refers to a learner that manifest difficulty in vision that even with correction, adversely affects a child educational performance. They include those that are totally blind, functionally blind or low
vision.
2. Difficulty in Hearing - refers to a learner that have difficulty in hearing, hard of hearing, suffering from hearing loss or deafness.
3. Difficulty in Applying Knowledge - refers to a learner that has a problem that interferes with learning basic skills such as reading, writing, acquiring skills and/or math. It can also delay higher level thinking skills such
as organization, time planning, abstract reasoning, long and short term memory and attention.
4. Difficulty in Remembering, Concentrating, Paying Attention and Understanding - refers to a learner that manifest significant limitations in general intellectual functioning; in adaptive functioning (communication,
self-care, home living, health and safety, social skills, functional academics, community use, leisure and work) which exist concurrently; it includes those medically diagnosed as learners with: Reading Disability or
Dyslexia; Written Expression Disability; Spelling Disability; Handwriting Disability or Dysgraphia; Mathematical Disability or Dyscalculia.
5. Difficulty in Performing Adaptive Skills (self-care) - refers to a learner manifesting difficulty in washing oneself, caring of body parts, toileting, dressing, eating and drinking.
6. Difficulty in Displaying Interpersonal Behavior (Emotional and Behavioral) - refers to a learner whose conditions are characterized by emotional or behavioral responses in school programs so different from
appropriate age, cultural or ethnic norms which affects their educational performance (academic, social, vocational or personal skills) more than temporary and responses are stressful to environment behavior is
exhibited in two different settings (one of which is school related). They are also unresponsive to direct intervention in general education.
7. Difficulty in Mobility (Walking, Climbing and Grasping) - refers to a learner that manifest difficulty in maintaining one’s position or changing a body position. They include those diagnosed as having cerebral palsy,
spina bifida and muscular dystrophy.
8. Difficulty in Communicating - refers to a learner whose developmental conditions are causing problems in communication, learning and social behaviors. It is typically characterized by difficulty in: Understanding
others; Producing message; Communicating using devices.
515377012.xlsx Table2 cont. Page 3 of 48
Table 3. NUMBER OF FUNCTIONAL ASSISTIVE TECHNOLOGY AND ADAPTIVE
DEVICES FOR LWDs, SY 2020-2021 (As of October 31, 2020)
Types of Devices Number of Devices
A. ASSISTIVE TECHNOLOGY DEVICES Notes:
1 Accessible Graphing Talking Calculator 1. Assistive Technology Device - refers to any device
that helps someone do something that might not
2 Amplified Answering Machines otherwise be able to do well or at all. Generally, the
term is used for devices that help people overcome a
3 Augmentative/Alternative Communication (AAC) Systems handicap such as a mobility, vision, mental, dexterity
or hearing loss.
4 Big Keys Keyboard
5 Bluetooth Hearing Aid
6 Braille Embosser-Double sided 2. Adaptive Device - refers to any device that are
used to assist with completing activities of daily
7 Braille Embosser-Single sided living.
8 Braille Machine
9 Braille Printer/Embosser
10 Braille Translation Software
11 Chair with Writing Board
12 Clerical Chair
13 Computer Printer
14 Computer Set
15 Crutches
16 Ergonomic trackballs
17 Foot Mouse
18 Head Mouse & Eye Trackers
19 Hearing Aid
20 Job Access with Speech (JAWS)
21 LCD Projector
22 Microsoft Screen Magnifier
23 Musical Instruments
24 One Touch Magic Screen
25 Remote Control with enlarged Buttons
26 Screen Reader
27 Sewing Machine
28 Talking Calculator
29 Talking Desktop
30 Tape Recorder
31 Telephone Amplifiers
32 Telescope
33 Wheelchair
TOTAL 0
B. ADAPTIVE DEVICES
1 Big Bubbles Kit
2 Buzzer
3 First Aid Kit
4 Rubber Mat
5 Safety Wall Mirror
6 Sleeping Bag
7 Speech Synthesizer
8 Stop Watch
9 Tent
10 Water Jug
11 Whistle
TOTAL 0
Reminder: Table 3 shall be accomplished ONLY by Elementary Schools and SPED Centers with SPED classes/programs.
School Head : 0 0
Position Title : 0 Position Title : 0
515377012.xlsx Table3 Page 4 o f 48

Table 4. NUMBER OF FUNCTIONAL EQUIPMENT AND TOOLS FOR LWDs
SY 2020-2021 (As of October 31, 2020)
Number of Equipment
Types of Equipment and Tools
and Tools
1 Blender Machine
2 Cake Turntable
3 Claw Hammer
4 Cross Cut Saw
5 Dipping Can
6 Double Boiler
7 Fire Extinguisher
8 Frying Pan
9 Garden Hose
10 Gas Range
11 Gloves
12 Kitchen Knife
13 Measuring Cups
14 Measuring Spoons
15 Mixing Bowl
16 Pastry Blender
17 Pastry Tubes
18 Pie Pan
19 Portable Electric Drill
20 Prunning Shear
21 Refrigerator
22 Roasting Pan
23 Seedling Tray
24 Sheet Pan
25 Spade
26 Spatula
27 Sprinkler
28 Strainer
29 Tong
30 Wooden Spoons
TOTAL 0
Note:
Equipment/Tools or Devices for LWDs are instructional supports and which are
appropriate assistive/materials or technology. These are powerful tool to increase a child's
independence and depending on disability or difficulty as down syndrome, hearing loss,
intellectual and learning disabilities, muscular dystrophy. This includes devices, equipment,
instruments and software .
Reminder: Table 4 shall be accomplished ONLY by Elementary Schools and SPED

Centers with SPED classes/programs.
Certified True and Correct by: Validated by Division SPED Coordinator:

School Head : 0 0
Validated by Planning Officer III (PRS-SGOD):
0
515377012.xlsx Table4 Page 5 of 48

Table 5. LEARNING RESOURCES NEEDED FOR THE LEARNERS WITH DISABILITIES (LWDs)
SY 2020-2021 (As of October 31, 2020)
Quantity
Needed for
DepEd
Classification/Types of Disabilities
Procured
Learning
Resources
With Diagnosis from Licensed Medical Specialist: Notes:

1. Visual Impairment DepEd procured Learning Resources (LRs ) - refers to the instructional materials provided by the
Central Office.
2. Hearing Impairment
3. Learning Disability
4. Intellectual Disability
5. Autism Spectrum Diaorder
6. Emotional-Behavioral Disorder
7. Orthopedic/Physical Handicap
8. Speech /Language Disorder
9. Cerebral Palsy
10. Special Health Problem/Chronic Disease
10.a. Cancer
11. Multiple Disabilities

Quantity
Learning Resouces for LWDs
Needed LWDs Materials:
Braille
LR
Digital Talking Book/ Braille - is a tactile system of reading and writing made up of raised dot patterns for letters, numbers, and
E-text punctuation marks use by people with visual impairment. Braille may be either embossed (a permanently
Large Print Font 16 printed document) or refreshable (electronically generated and accessed via a braille display device).
Large Print Font 17
Large Print Font 18

Digital Talking Book/ E-text - provides electronic content that is delivered on a computer or another
Large Print Font 19 device. Electronic content can be changed in many ways (e.g., size, contrast, read aloud) to accommodate
Large Print Font 20 the needs and preferences of a learner. Content is presented dependent on the technology and learner's
needs.
Large Print Font 21
Large Print Font 22

Large Print - refers to formatting of book or other text document where the typeface (or font), and
Large Print Font 23
medium are considerably larger than usual to accommodate learners who have poor vision.
Large Print Font 24
Large Print Font 25 Pencil (Claw), Grips (small, medium, and large) - for all grade levels are pencil grips that place the
Large Print Font 26 fingers of the learners in the correct position.
Large Print Font 27
Large Print Font 28 Sign language dictionary - it’s a compilation of term and language done through finger signing.
Large Print Font 29
Large Print Font 30

Sign language charts with text and braille - with braille and text (numbers 0-9, alphabet, why, where,
when, what, who, how, colors, and other basic sign language)
Pencil (Claw) Grips Small
Pencil (Claw) Grips Medium Sharpie pens - are pens for low vision learners that create easy to see and read, highly visible, crisp, bold,
Pencil (Claw) Grips Large black line which do not smudge or bleed through in most paper.
Sign language dictionary Stylus and Slates (board slates) - are tools used by learners with visual impairment to write braille that
they can read without assistance.
Sign language charts with Text and Braille
Taylor Slate - is arithmetic and algebra device consists of a rectangular aluminum type frame, 432
Sharpie pens octagonal cells are stamped in the top in an 18 x 24 grid, with a recessed compartment at one end for
Stylus and Slates holding the extra type when the frame is in use.
(Board slates)
Tailor Slate Drawing kit - is a set of brailled ruler, triangles, protractor, compass, and drawing board that are used to
Drawing Kit draw raised geometrical figures.
Bocce Ball Sets Bocce Ball Sets - are sport equipment use in paragames.
Goal Ball Goal Ball - is a sport equipment use in paragames.
Duralex glasses, mugs, bowls, plates Duralexglasses, mugs, bowls, and plates - are breakable but LWD friendly.
School Head : 0 0

Table 6. TEACHERS HANDLING LEARNERS WITH DISABILITIES (LWDs) (Nationally-funded teachers only), SY 2020-2021 (As of October 31, 2020)
Number of Teachers Handling Learners with Types of Disabilities Years in Service Years of Teaching LWDs
ASD/ EBD/ Two (2) or

LD/
Position Title VI/ HI/ ID/ Difficulty in Difficulty in OH/ ComDics/ More Types 16 years 13 years
Difficulty in Multiple 0-3 4-6 7-9 10-12 13-15 0-3 4-6 7-9 10-12
Difficulty in Difficulty in Difficulty in Performing Displaying Difficulty in Difficuly in of LWDs and and
Applying Disabilities years years years years years years years years years
Seeing Hearing Remembering Adaptive Interpersonal Mobility Communicating (Mixed above above
Knowledge
Skills Behavior LWD)
Master Teacher IV
Master Teacher III
Master Teacher II
Master Teacher I
Teacher III
Teacher II
Teacher I
TOTAL 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Notes:
1. If a teacher is handling group of learners with two (2) or more types of disabilities, he/she shall be counted in "Multiple Disabilities".
2. If a teacher is handling learners with different disabilities or combinations of LWDs, he/she shall be counted in "Two (2) or More Types of LWDs (Mixed LWDs)".
3. Years in Service - refers to the number of years in service as a teacher.
4. Years of Teaching LWDs - refers to the number of years of teaching LWD.
Certified True and Correct by: Validated by Division HR Personnel: Validated by Division SPED Coordinator: Validated by Planning Officer III (PRS-SGOD):
School Head : 0 0 0
(Signature Over Printed Name) (Signature Over Printed Name) (Signature Over Printed Name) 0
Position Title : 0 Position Title : 0 Position Title : 0

Table 7. LOCALLY-FUNDED TEACHERS WORKING IN THE SCHOOL BY FUNDING SOURCE, SY 2020-2021 (As of October 31, 2020)
Funding Source
Class Special Education Fund (SEF) TOTAL
Local Gov't Unit (LGU)
Others Locally-funded
Provincial Municipal/City funded
Teachers
Kindergarten * 0
Elementary (excluding handling ALIVE classes) 0
Notes:
Locally-funded teachers working in the school - teachers not having plantilla positions and whose compensation is chargeable against the local budget.
These are classified according to the following:
a. Special Education Fund (SEF) Teachers - teachers whose salaries are being paid by the Local School Board Fund (Provincial or Municipal/City) where the school is located.
b. Local Government Unit (LGU) funded Teachers - teachers paid out of the general fund (not the SEF) of the LGU.
c. Others - teachers who are being funded by other sources not mentioned above (e.g., Parents-Teachers Association, etc.).
Reminders: 1. * - Those serving two or more schools simultaneously shall be counted only in the school with the most teaching loads or number of learners handled, in that order.
2. - Total of Locally-funded Teachers can be greater than or equal to the Total of Qualified / Trained Teachers in Table 8.
Table 8. LOCALLY-FUNDED TEACHERS WORKING IN THE SCHOOL WHO ARE QUALIFIED AND TRAINED
SY 2020-2021 (As of October 31, 2020)
Qualified Teachers Trained Teachers
Class
Male Female TOTAL Male Female TOTAL Validated by Senior Education Program Specialist (HRTD):
Kindergarten * 0 0
Signature Over Printed Name
Elementary (excluding handling ALIVE classes) 0 0
Notes:
1. Qualified teacher - locally-funded teacher who has the minimum academic qualifications necessary to teach Elementary School Education. He/She must be a Licensure Examination for
Teacher (LET) passer given by the Professional Regulation Commission (PRC) and the Board for Professional Teachers (BPT) or a Professional Board Examination for Teachers (PBET) passer
given by the Civil Service Commission (CSC) and Department of Education, Culture and Sports (DECS [now DepEd]).
2. Trained teacher - locally funded teacher who received at least the minimum organized teacher-training requirements (pre-service or in-service) to teach Elementary School Education.
Reminders: 1. * - Those serving two or more schools simultaneously shall be counted only in the school with the most teaching loads or number of learners handled, in that order.
2. - Total of Qualified / Trained Teachers shall be less than or equal to the Total of Locally-funded Teachers in Table 7.
Table 9. DEPARTMENT OF EDUCATION (DepEd) SUBSIDIZED CONTRACT OF SERVICE (COS)

TEACHERS/ASATIDZ HANDLING ALIVE CLASSES, SY 2020-2021 (As of October 31, 2020)
DepEd Subsidized Contract of Service (COS) Teachers/Asatidz Validated by Division ALIVE Coordinator:
Male Female TOTAL

Signature Over Printed Name
0
Note: ASATIDZ DepEd Subsidized/COS Teachers - assigned to teach ALIVE classes and not Position Title :
having plantilla positions but paid by DepEd through honorarium.
Reminder: Those serving two or more schools simultaneously shall be counted only in the school with the most teaching loads or number of learners handled, in that order.
Certified True and Correct by: Validated by Division HR Personnel: Validated by Planning Officer III (PRS-SGOD):
School Head : 0
(Signature Over Printed Name) / Date (Signature Over Printed Name) 0
515377012.xlsx Tables7,8,9 Page 8 of 48
Table 10. TEACHING RELATED AND NON-TEACHING PERSONNEL (Nationally-funded), SY 2020-2021 (As of October 31, 2020)
NATIONALLY-FUNDED PERSONNEL
POSITIONS ASSIGNED IN THE SCHOOL
Personnel detailed to TOTAL
Personnel borrowed from other
Number of Number of personnel actually working Nationally-funded personnel working
school(s)/ DepEd office(s)
positions in the school in the school
Position Title assigned in DepEd office(s)/ TOTAL TOTAL
the school Position(s) DepEd Secondary school(s) outside
On leave office(s) school(s) the division or
per latest vacant (Col.5+Col.6 +
TOTAL TOTAL Male Female TOTAL
PSI-POP within the within the other (Col.8+Col.9+
Col.7+Col.11 )
Male Female division division government Col.10) Male Female
(Col.3+Col.4) agencies (Col.13+Col.14) (Col.3+Col.13) (Col.4+Col.14) (Col.16+Col.17)
Col. 1 Col. 2 Col. 3 Col. 4 Col. 5 Col. 6 Col. 7 Col. 8 Col. 9 Col. 10 Col. 11 Col. 12 Col. 13 Col. 14 Col. 15 Col. 16 Col. 17 Col. 18
School Principal IV 0 0 0 0 0 0 0
School Principal III 0 0 0 0 0 0 0
School Principal II 0 0 0 0 0 0 0
School Principal I 0 0 0 0 0 0 0
Head Teacher VI 0 0 0 0 0 0 0
Head Teacher V 0 0 0 0 0 0 0
Head Teacher IV 0 0 0 0 0 0 0
Head Teacher III 0 0 0 0 0 0 0
Head Teacher II 0 0 0 0 0 0 0
Head Teacher I 0 0 0 0 0 0 0
Guidance Coordinator III 0 0 0 0 0 0 0
Guidance Coordinator II 0 0 0 0 0 0 0
Guidance Coordinator I 0 0 0 0 0 0 0
Guidance Counselor III 0 0 0 0 0 0 0
Guidance Counselor II 0 0 0 0 0 0 0
Guidance Counselor I 0 0 0 0 0 0 0
Administrative Assistant III

0 0 0 0 0 0 0
(Senior Bookkeeper)
Administrative Assistant II
0 0 0 0 0 0 0
(Disbursing Officer II)
Security Guard 0 0 0 0 0 0 0
Utility Worker I 0 0 0 0 0 0 0
TOTAL 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Reminders: 1. Totals in column 12 shall tally with entries in column 2.

2. For the definitions, refer to Teaching Personnel Data (Table 11).
School Head : 0 0
Table 11. TEACHING PERSONNEL (Nationally-funded), SY 2020-2021 (As of October 31, 2020)
NATIONALLY-FUNDED PERSONNEL
Number of positions assigned in the POSITIONS ASSIGNED IN THE SCHOOL
school per latest PSI-POP Teachers detailed to TOTAL
Teachers borrowed from other
Number of teachers actually working Nationally-funded teachers working
Position Title school(s)/ DepEd office(s)
in the school
in the school DepEd office(s)/ TOTAL
Items DepEd Secondary school(s) outside TOTAL
As of Created from TOTAL Position(s)
On leave office(s) school(s) the division or
March 31, April 1 to TOTAL Vacant (Col.5+Col.6 + TOTAL Male Female TOTAL
2020 October 31, within the within the other (Col.8+Col.9+ Col.7+Col.11 )
Male Female division division government Col.10) Male Female
2020
(2a+2b) (Col.3+Col.4) agencies (Col.13+Col.14) (Col.3+Col.13) (Col.4+Col.14) (Col.16+Col.17)
Col. 1 (2a) (2b) Col. 2 Col. 3 Col. 4 Col. 5 Col. 6 Col. 7 Col. 8 Col. 9 Col. 10 Col. 11 Col. 12 Col. 13 Col. 14 Col. 15 Col. 16 Col. 17 Col. 18
a. Teaching Positions
Master Teacher IV 0 0 0 0 0 0 0 0
Master Teacher III 0 0 0 0 0 0 0 0
Master Teacher II 0 0 0 0 0 0 0 0
Master Teacher I 0 0 0 0 0 0 0 0
Teacher III 0 0 0 0 0 0 0 0
Teacher II 0 0 0 0 0 0 0 0
Teacher I 0 0 0 0 0 0 0 0
SPED Teacher V 0 0 0 0 0 0 0 0
SPED Teacher IV 0 0 0 0 0 0 0 0
SPED Teacher III 0 0 0 0 0 0 0 0
SPED Teacher II 0 0 0 0 0 0 0 0
SPED Teacher I 0 0 0 0 0 0 0 0
TOTAL 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. Assignment (Number of teachers actually working in the school):

Handling Kindergarten classes 0 0 0 0 0
Handling Grades 1-6 0 0 0 0 0
Handling ALIVE classes 0 0 0 0 0
Handling SPED classes 0 0 0 0 0
Handling ALS classes (Mobile Teacher) 0 0 0 0 0
District ALS Coordinator 0 0 0 0 0
School ALS Coordinator 0 0 0 0 0
Handling Full Time Ancilliary Services 0 0 0 0 0
TOTAL 0 0 0 0 0 0 0 0 0
1. Nationally-funded personnel - teaching, teaching-related and non-teaching personnel having plantilla positions, including those with provisional appointments.
2. Number of positions assigned in the school per latest PSI-POP - number of plantilla items assigned to the school.
3. Number of teachers actually working in the school - teaching, teaching-related and non-teaching personnel with plantilla positions who are actually performing their specific assignments in the school.
4. On leave personnel - personnel who are on leave for the whole school year approved by the School Division Superintendent.
5. Position(s) vacant - plantilla positions that are unfilled whether existing plantilla or newly created positions.
6. Personnel detailed to DepEd office(s) within the division - personnel assigned/designated to the district office or to the division office.
7. Personnel detailed to Secondary school(s) within the division - personnel assigned/designated to secondary schools within the division.
8. Personnel detailed to DepEd office(s)/school(s) outside the division or other government agencies - personnel assigned/designated to other DepEd office(s)/school(s) outside the division or other government agencies.
9. Personnel borrowed from other school(s)/ DepEd office(s) - personnel who are actually working in the school but whose items belong from secondary school(s) or from other DepEd office(s) like the district, division, regional, central office or from other school division(s).
Reminders: 1. In Table 11a, totals in column 12 shall tally with entries in column 2.
2. In Table 11b, if a teacher is handling two or more assignments, he/she shall be counted in his/her assignment where he/she has the most number of loads.
3. Totals in Tables 11a & 11b shall tally.
4. In Table 11a, totals in column 18 shall tally with entries in Table 12 column 7.
5. In Table 11b, entries in Handling Kindergarten classes, Handling Grades 1-6 and Handling SPED classes in columns 3, 4 & 5 shall tally with the entries in the Number of Teachers (counted only once) in Table 16.
School Head : 0 0
(Signature Over Printed Name) / Date

Table 12. TEACHER ASSIGNMENTS (Nationally-funded teachers working in the school), SY 2020-2021 (As of October 31, 2020)
Carries full-time class teaching load Assigned part-time to class teaching,
(360 min. or more) part-time to ancillary services Assigned full-time to TOTAL
Position Title (Col.2+Col.3+Col.4+
Not assigned to ancillary Assigned to ancillary services Class teaching 200 min. per Class teaching less than 200 ancillary services Col.5+Col.6)
services as additional load day or more min. per day
Col. 1 Col. 2 Col. 3 Col. 4 Col. 5 Col. 6 Col. 7
Master Teacher IV 0
Master Teacher III 0
Master Teacher II 0
Master Teacher I 0
Teacher III 0
Teacher II 0
Teacher I 0
SPED Teacher V 0
SPED Teacher IV 0
SPED Teacher III 0
SPED Teacher II 0
SPED Teacher I 0
TOTAL 0 0 0 0 0 0
Notes:
1. Full-time Teachers – refers to teachers who carry/render full-time class teaching load of 360 minutes or more per day with or without assigned ancillary services.
2. Part-time Teachers – refers to teachers who carry/render part-time class teaching load of less than 360 minutes per day and part-time to ancillary services.
3. Ancillary services - those rendered as a guidance teacher, librarian, property custodian, office clerk, canteen manager, coordinator (ALS, Boy/Girl Scout, etc.), teacher nurse. Class advisorship is not included.
Reminder: Totals in column 7 of this table shall be equal to the totals in Table 11 a (column 18 - Total Nationally-funded teachers working in the school).
Table 13. TEACHERS WHO RECEIVED TRAINING WHILE IN-SERVICE FROM JULY 2019 TO JUNE 2020
(Nationally-funded teachers working in the school)
Number of Teachers
Position Title
Male Female TOTAL
Master Teacher IV 0
Master Teacher III 0
Master Teacher II 0
Master Teacher I 0 Validated by Senior Education Program Specialist (HRTD):
Teacher III 0
Teacher II 0 0
Signature Over Printed Name / Date
Teacher I 0
SPED Teacher V 0
SPED Teacher IV 0
SPED Teacher III 0
SPED Teacher II 0
SPED Teacher I 0
TOTAL 0 0 0
Note: Number of teachers who received training relevant to the subject matter they are teaching for the past twelve (12) months.
School Head : 0 0
515377012.xlsx Tables12-13 Page 11 of 48
Table 14. TEACHERS WHO RECEIVED TRAINING ON INFORMATION AND COMMUNICATIONS TECHNOLOGY (ICT)
Number of Teachers
Training on ICT Kindergarten Grades 1 to 6 TOTAL (Kindergarten to Grade 6)
Male Female TOTAL Male Female TOTAL Male Female TOTAL
ICT Integration 0 0 0 0 0
ICT Literacy/Content 0 0 0 0 0
Software 0 0 0 0 0
Hardware 0 0 0 0 0
Others 0 0 0 0 0
TOTAL 0 0 0 0 0 0 0 0 0
Notes:
1. ICT Integration - it is a strategy to incorporate information and communications technology into all facets of education and training, including the
administrative functions and models required to support learning.
2. ICT Literacy/Content - knowledge to use digital technology, communication tools, and/or networks appropriately to solve information problems in
order to function in an information society.
3. Software - refers to the programs and other operating information used by a computer.
4. Hardware - refers to the machines, writing, and other physical components of a computer or other electronic system.
5. Others - refers to the other training on ICT.
Reminder: If a teacher is receiving more than one training on ICT, he/she can be counted more than once.
Table 15. TEACHERS WHO RECEIVED TRAINING ON PEDAGOGY

Number of Teachers
Training on Pedagogy Kindergarten Grades 1 to 6 TOTAL (Kindergarten to Grade 6)
Male Female TOTAL Male Female TOTAL Male Female TOTAL
Constructivist 0 0 0 0 0
Inquiry based 0 0 0 0 0
Reflective 0 0 0 0 0
Collaborative 0 0 0 0 0
Integrative 0 0 0 0 0
Inclusive Education 0 0 0 0 0
Others 0 0 0 0 0
TOTAL 0 0 0 0 0 0 0 0 0
Notes:
1. Pedagogy - strategies/approaches in teaching and learning. Based on RA 10533; Rule 2, Section 10.2.
2. Constructivist teaching - based on the belief that learning occurs as learners are actively involved in a process of meaning and knowledge
construction as opposed to passively receiving information.
3. Inquiry based - is a form of active learning that starts by posing questions, problems or scenarios-rather than simply presenting established facts or
portraying a smooth path to knowledge.
4. Reflective teaching - means looking at what you do in the classroom, thinking about why you do it, and thinking about if it works - a process of
self-observation and self-evaluation.
5. Collaborative learning - is a method of teaching and learning in which learners team together to explore a significant question or create a
meaningful project.
6. Integrated approach - allows learners to explore, gather, process, refine and represent information about topics they want to investigate without
the constraints imposed by traditional subject barriers (Pigdon and Wolly, 1992).
7. Inclusive Education - embraces the philosophy of accepting all children regardless of race, size, shape, color, ability or disability with support
from school staff, learners, parents and the community (DepED Order No. 72, s. 2009).
8. Others - refers to the other training on Pedagogy.
Reminder: If a teacher is receiving more than one training on pedagogy, he/she can be counted more than once.
Certified True and Correct by: Validated by Senior Education Program Specialist (HRTD): Validated by Planning Officer III (PRS-SGOD):
School Head : 0
(Signature Over Printed Name) 0 0
Position Title : 0
Table 16. NUMBER OF TEACHERS BY GRADE LEVEL Table 17. NUMBER OF TEACHERS BY TEACHING ASSIGNMENT IN GRADES 4 TO 6
(Nationally-funded teachers actually working in the school), SY 2020-2021 (As of October 31, 2020) (Nationally-funded teachers actually working in the school), SY 2020-2021 (As of October 31, 2020)
Number of Teachers
Grade 4 Grade 5 Grade 6
Grade Level Counted only once * Counted more than once ** Learning Areas
Male Female TOTAL Male Female TOTAL Male Female TOTAL Male Female TOTAL Male Female TOTAL
Kindergarten 0 0 English 0 0 0
Grade 1 0 0 Mathematics 0 0 0
Grade 2 0 0 Filipino 0 0 0
Grade 3 0 0 Science 0 0 0
Grade 4 0 0 Araling Panlipunan (AP) 0 0 0
Edukasyong Pantahanan at Pangkabuhayan (EPP)/

Grade 5 0 0 0 0 0
Technology and Livelihood Education (TLE)
Grade 6 0 0 Music, Art, Physical Education, Health (MAPEH) 0 0 0
SPED 0 0 Edukasyon sa Pagpapakatao (EsP) 0 0 0
TOTAL 0 0 0 0 0 0 TOTAL 0 0 0 0 0 0 0 0 0
Notes: Note:
1. * Number of teachers that shall be counted only once • If a teacher is teaching more than one learning area or grade level, he/she can be counted more than once.
If a teacher is teaching more than one grade, he/she shall be counted to the grade level where he/she
teaches the most number of hours.
However, if he/she teaches an equal number of hours per grade level, he/she shall be counted to the highest
Reminder:
grade level assignment.
• Totals of Grades 4, 5 and 6 of this table shall be greater than or equal to the entries of Grades 4, 5 and 6 in Table 16.
2. ** Number of teachers that can be counted more than once
If a teacher is teaching more than one grade level, he/she can be counted more than once.
Reminders:
1. Entries in the Number of teachers (counted only once) shall tally with the entries in
Handling Kindergarten classes, Handling Grades 1-6 and Handling SPED classes in
columns 3, 4 & 5 in Table 11b.
2. Entries of Grades 4, 5 and 6 (counted only once) of this table shall be less than or equal to the
totals of Grades 4, 5, 6 in Table 17.
School Head : 0 0

Table 18. NUMBER OF TEACHERS BY HIGHEST EDUCATIONAL ATTAINMENT
(Nationally-funded teachers only), SY 2020-2021 (As of October 31, 2020)
Number of Teachers
Highest Educational Attainment
Male Female TOTAL
Bachelor Degree 0 Validated by Division HR Personnel:
Master Degree Units 0
Master Degree 0 0
Doctorate Degree Units 0 (Signature Over Printed Name)
Doctorate Degree 0 Position Title : 0

TOTAL 0 0 0
Reminder: A teacher shall be counted based on his/her highest level of educational attainment regardless if it is
related to his/her specialization/subject or not (i.e., Master of Public Administration [MPA], Master in Business
Administration [MBA], etc.).
Box 1. LEARNING ACTION CELL (LAC) SESSIONS, SY 2020-2021 (As of October 31, 2020)
(Check/Provide appropriate answers)
Validated by Curriculum Implementation Division (CID) Personnel:
1. Do you conduct LAC Session/s in your school? 0 Yes No
✘
If Yes, indicate the number of LAC Session/s conducted:
1.a. Conducted last SY 2019-2020 (Signature Over Printed Name)
1.b. Planned to be conducted this SY 2020-2021 Position Title :
Box 2. ACTION RESEARCH, SY 2020-2021 (As of October 31, 2020)

1. Do you conduct Action Research in your school? 0 Yes No Validated by Senior Education Program Specialist (PRS-SGOD):
If Yes, indicate the number of Action Research conducted:
1.a. Completed last SY 2019-2020
1.b. On-going (Signature Over Printed Name)
1.c. To be conducted
Certified True and Correct by: Validated by Planning Officer III (PRS-SGOD):
School Head : 0
(Signature Over Printed Name) / Date 0
Position Title : (Signature Over Printed Name)
0
515377012.xlsx Table18-Boxes1-2 Page 14 of 48
Box 3. SCHOOL GOVERNMENT PROGRAM (SGP), SY 2020-2021 (As of October 31, 2020)
1. Do you have a Supreme Pupils Government (SPG) Council? 0 Yes
✘
No
2. Do you have a SPG Adviser? 0 Yes No
2.a. If Yes, for how many years as adviser?
3. What is/are the subject/s handled by the adviser?
0 Science 0 Mathematics 0 Others, (specify)
0 Filipino 0 Araling Panlipunan (AP)
4. What is the highest academic degree of the adviser?
0 Bachelor Degree 0 Master Degree 0 Doctorate Degree
0 Master Degree Units 0 Doctorate Degree Units
5. Are the SPG Adviser deloaded of some of their subjects handled? 0 Yes No
6. Does the school collect fees for the SPG acivities? 0 Yes No
7. Did the school incorporate a budget for SPG as part of SIP/APP? 0 Yes No
8. Does the school have a room dedicated for the SPG Council? 0 Yes No
9. Have the school SPG joined a division search for best SPG Council? 0 Yes No
10. Have your division won any National Award? 0 Yes No
11. How many times have the Youth Formation Coordinator (YFC)/Project Development Officer I
(PDO I) visited the school?
12. Do you provide Compensatory Time Off (CTO) for activities conducted by SPG advisers during
Saturday? 0 Yes No
Box 4. SUPREME PUPILS GOVERNMENT (SPG) ACTIVITIES, SY 2020-2021 (As of October 31, 2020)
(Check appropriate answers)
1. Have the SPG organized the participation of learners in Brigada Eskwela? 0 Yes No
2. Have the school lead in National Greening Program? 0 Yes No
3. Have the school conduct activities and awareness campaigns to encourage parents to enlist their
five (5) year old children for kindergarten? 0 Yes No
4. Have the school conducted book and toy drive and other school supplies for donation to schools
with kindergarten? 0 Yes No
5. Have the school SPG conducted activities to prevent learners from dropping-out of schools? 0 Yes No
6. Have the school SPG conducted English Speaking Campaigns and Reading and Tutorial Services? 0 Yes No
7. Have the school SPG conducted activities to support Anti-Drug Abuse Education and Campaign? 0 Yes No
8. Have the school SPG assisted in ensuring that the school is a smoke/tobacco free place? 0 Yes No
9. Have the school SPG lead learners in organizing activities which start during the Teachers' Month
Campaign every September and which culminate during the World Teachers' Day celebration on 0 Yes No
October 5?
10. Have the school SPG encourage and support the participation of learners in recognized co-
curricular clubs/organizations and activities? 0 Yes No
Box 5. CAREER GUIDANCE PROGRAM, SY 2020-2021 (As of October 31, 2020)

(Check/provide appropriate answers)
1. Do you have a school guidance counselor? 0 Yes No

If Yes, shall provide data on Guidance Counselor in Table 10.
2. How many years he/she is assigned as guidance counselor?
3. Do you have a guidance advocate? ✘
Yes No
4. How many years he/she is as guidance advocate?
5. Have you conducted a career guidance activity? 0 Yes No
6. Has the school funded a career guidance activity? 0 Yes No
7. Do you have a guidance office? 0 Yes No
Certified True and Correct by: Validated by Division Youth Formation Coordinator: Validated by Planning Officer III (PRS-SGOD):
School Head : 0
515377012.xlsx Boxes3-5 Page 15 of 48

Table 19. NUMBER OF FUNCTIONAL COMPUTERS IN THE SCHOOL BY FUNDING SOURCE, SY 2020-2021 (As of October 31, 2020)
(Provide appropriate answers)
NUMBER OF FUNCTIONAL COMPUTERS BY FUNDING SOURCE
Types of Computer Other

DepEd DepEd
LGU/SEF PTA Private Donations Government Others TOTAL
DCP non-DCP
Agencies
Academic Use
Desktop 0
Notebook/Netbook 0
Tablet 0
Desktop Virtual Terminal 0
Administrative Use
Desktop 0
Notebook/Netbook 0
Tablet 0
Desktop Virtual Terminal 0
TOTAL 0 0 0 0 0 0 0 0
Notes:
1. Indicate the number of functional computers according to the following funding sources:
a. DepEd DCP - computers procured through the DepEd Computerization Program.
b. DepEd non-DCP - computers procured through other DepEd downloaded funds.
c. LGU/SEF - computers procured from the Special Education Fund (SEF) and the budgets of Local Government Units (LGU): provincial, municipal or barangay units.
d. PTA - computers funded from the Parents-Teachers Association (PTA).
e. Private Donations - computers donated/procured by private individuals, corporations, alumni associations, non-government organizations, philanthropic organizations or through foreign-assisted funds.
f. Other Government Agencies - computers funded from other government agencies such as DTI, DOST, CICT, etc.
g. Others - computers procured from other sources not listed above.
2. Computer - refers to electronic devices for storing and processing data such as :
a. Desktop - refers to a computer that is designed to be used on a table.
b. Notebook/Netbook - refers to a laptop computer that can easily be transported.
c. Tablet - refers to a portable computer that has a touchscreen feature as the primary means of input.
d. Desktop Virtual Terminal - refers to a computer terminal consisting of monitor, keyboard and mouse connected to a terminal device that connects to a computer host.
(Reminder: Do not count the computer host.)
3. Computer for Academic Use - refers to computer units utilized in the classroom/laboratory as an aid to instruction.
4. Computer for Administrative Use - refers to computer units used for encoding administrative data of the school (e.g., enrolment, attendance, disbursements, financial statements, and other reports).
Certified True and Correct by: Validated by Information Technology Officer: Validated by Planning Officer III (PRS-SGOD):
School Head : 0
(Signature Over Printed Name) 0
Position Title : 0
Table 20. NUMBER OF FUNCTIONAL ICT EQUIPMENT IN THE SCHOOL BY FUNDING SOURCE, SY 2020-2021 (As of October 31, 2020)
NUMBER OF FUNCTIONAL ICT EQUIPMENT BY FUNDING SOURCE
Types of ICT Equipment Other

DepEd DepEd
LGU/SEF PTA Private Donations Government Others TOTAL
DCP non-DCP
Agencies
Academic Use
LED TV 0
Network Switch 0
Printer 0
Projector 0
UPS 0
Wireless Router 0
Administrative Use
LED TV 0
Network Switch 0
Printer 0
Projector 0
UPS 0
Wireless Router 0
TOTAL 0 0 0 0 0 0 0 0
Notes:
ICT Equipment - refers to electronic devices such as hardware and software that are intended to perform information processing and communication functions.
1. LED TV - refers to a type of television that uses light-emitting diodes (LED).
2. Network Switch - refers to a device used to network multiple computers together.
3. Printer - refers to a machine for printing text or illustrations on paper.
4. Projector- refers to a machine that projects images onto a screen or a wall.
5. Uninterruptible Power Source (UPS) - refers to an electronic equipment that provides battery backup when the electrical power source fails.
6. Wireless Router - refers to electronic device that works as router and as a wireless access point, to provide access to the internet or a private computer network.
School Head : 0
Position Title : 0
Box 6. INTERNET CONNECTIVITY, SY 2020-2021 (As of October 31, 2020)
1. Are there internet service providers in the area? ✘ 0 Yes No

If Yes, check the appropriate internet service provider/s servicing the area:
0 BAYANTEL 0 GLOBE 0 SMART 0 WIT Global (Satellite)
0 DIGITEL 0 PLDT 0 SUN 0 Others, (specify)
2. Does the school subscribe to any of the internet service provider/s listed above? 0 Yes No
If Yes, check the purpose:
0 For administrative use
0 For classroom instruction use
3. How fast is your internet connection when not in use? Use www.speedtest.net to test the speed.
Date Tested: Ping (ms): Upload (Mbps):
Time Tested: Download (Mbps):
Note: Internet Service Provider (ISP) - refers to the organization that provides services for accessing, using, or participating in the internet.
Table 21. AVERAGE MONTHLY EXPENSE (IN PESOS) OF INTERNET CONNECTION BY FUNDING SOURCE, SY 2020-2021 (As of October 31, 2020)
Types of Internet Connection Internet Service Provider Average Monthly Expense Funding Source
(Wired, Fixed wireless, Satellite, (Select from available ISPs above) (in PhP)
USB Modem) (DepEd DICP, MOOE, School Funds, LGU/SEF, PTA,
Private Donations, Other Government Agencies, etc.)
Notes:
1. Types of Internet Connection:
a. Wired - internet connection using the phone lines from the service provider to a client.
b. Fixed wireless - internet connection through radio frequency bands with directional radio antenna on each end of the signal.
c. Satellite - internet connection using satellite dish supplied by an internet provider.
d. USB Modem - internet connection using USB dongle (e.g., SMART Bro, Globe Tattoo).
2. Average Monthly Expense - average cost spent in Philippine Peso for the internet connection by type, ISP and funding source.
Reminder: This table shall be filled out if the school subscribe to any internet service provider or if the answer is "YES" in Box 6 Item number 2.
School Head : 0
Position Title : 0
515377012.xlsx Box6-Table21 Page 18 of 48
Table 22. MOOE ALLOCATION, UTILIZATION AND LIQUIDATION Box 7. AVAILABILITY OF ELECTRICAL SUPPLY, SY 2020-2021 (As of Octobert 31, 2020)
FROM JANUARY 2019 TO DECEMBER 2019 (Check/Provide appropriate answers)
MOOE Amount in PhP 1. Electrical Supply Sources:
Allocation ✘0 Grid Supply
Utilization 0 Off Grid Supply
Liquidation 0 Solar Power
Notes: 0 Generator
1. Maintenance and Other Operating Expenses (MOOE) - is the 0 Others, (specify)
allocated funds for public elementary and secondary schools that can be
spent on activities and necessities (i.e. electricity and water) that 0 No source of electricity
support learning programs and help maintain a safe and healthy
environment in schools. 2. Average Cost of Monthly Bills/Maintenance: (Indicate the amount in PhP)
3. What is the funding source?
2. MOOE Allocation - refers to the MOOE provided for the previous 0 School MOOE 0 School Canteen Fund
fiscal year.
0 LGU 0 Private Individual/Sector
3. MOOE Utilization - refers to the amount of MOOE utilized from the 0 PTA 0 Others, (specify)
MOOE allocation of the previous fiscal year.
4. Number of hours that the electricity is usually available in a day:
4. MOOE Liquidation - refers to the amount of MOOE liquidated from
the MOOE utilized from the MOOE allocation of the previous fiscal Notes:
year.
1. Grid Supply - electricity coming from major or local power distributors (e.g., electric cooperatives such as ANTECO,
BASELCO, CASURECO, MERALCO, NAPOCOR, etc.).
2. Off Grid Supply - electricity coming from alternative source of power (e.g., solar power, generator, hydro electric, micro
hydro, wind turbine, windmill, etc.).
3. No source of electricity - without existing electrical supply at all.
Validated by Division Accountant: Validated by Phy. Facilities Coordinator/Div. Engineer:

0
(Signature Over Printed Name) / Date (Signature Over Printed Name) / Date
Position Title : Position Title : 0
Certified True and Correct by: Validated by Planning Officer III (PRS-SGOD):
School Head : 0
(Signature Over Printed Name) / Date 0
(Signature Over Printed Name) / Date
Position Title : 0
515377012.xlsx Table22-Box7 Page 19 of 48

Box 8. SCHOOL SITE, SY 2020-2021 (As of October 31, 2020)
1. School Site Ownership and / or Proof of Occupancy
2. Total Land Area (in square meters): 4. Within Ancestral Domain :
a. Ownership in the name of: With Usufruct Agreement?
✘0 DepEd 0 Other Government Agency 3. Mode of Acquisition of School Site: 0 Yes No
0 LGU 0 Private Entity / Individual/s Year With Certificate of Ancestral Domain Title (CADT)?
Mode
Acquired 0 Yes No
b. With Document? 0 Yes No 0 Donation
If Yes, what Document Type: 0 Purchase 5. Within Ancestral Land :
0 Original Certificate of Title (OCT) 0 Usufruct Agreement With Usufruct Agreement?
0 Transfer Certificate of Title (TCT) 0 Expropriation 0 Yes No
0 Certificate of Land Ownership Award (CLOA) 0 Deed of Exchange (Land Swapping) With Certificate of Ancestral Land Title (CALT)?
0 Special Patent 0 Presidential Proclamation 0 Yes No
0 Presidential Proclamation 0 Special Patent
0 Tax Declaration 0 Certificate of Land Ownership Award 6. Legal Ownership Issues :
(CLOA)
0 Deed of Absolute Sale 0 With Adverse Claim
0 Deed of Donation 0 Special Land Use Permit (SLUP) 0 Encroachment
0 Certificate of Stewardship 0 Others, (specify) 0 With Illegal Settlers
0 Special Land Use Permit (SLUP) 0 Others, (specify)
0 Contract of Usufruct
0 Memorandum of Agreement or Understanding 7. School Site within :
0 Lease Agreement 0 Protected Areas
0 Others, (specify) 0 Areas classified as Timberland and Forestland
Notes:
1. School Site Ownership and / or Proof of Occupancy - refers to any legal and official document that acts as a competent proof of one's ownership and/or occupancy of the subject property.
Document Type:
Certificate of Title - refers to the transcript of the decree or registration made by the Register of Deeds.
a. Original Certificate of Title (OCT) - refers to a document when the land has been adjudicated and decreed in the name of its owner in registration proceeding and the title issued for the first time is pursuant of such decree.
b. Transfer Certificate of Title (TCT) - refers to a document when the land title is cancelled and replaced by another title by reason of sale or transfer.
c. Certificate of Land Ownership Award (CLOA) - refers to a proof of ownership of the agrarian reform beneficiary with respect to private and agricultural land covered under RA 6657.
d. Special Patent - refers to grant, cede, and convey full ownership of alienable and disposable lands formerly covered by a reservation of lands of the public domain and is issued upon the promulgation of a special law or act of
Congress or by the DENR Secretary as authorized by the President.
e. Presidential Proclamation - refers to a proclamation issued by the President reserving an untitled land for public use.
f. Tax Declaration - refers to a document issued by the Assessor's Office of the jurisdiction (e.g., city or municipality) evidencing the payment of taxes on the use of the real property.
g. Deed of Absolute Sale - refers to a document executed by the vendor evidencing the absolute (without conditions) sale of the real property in favor of the vendee.
h. Deed of Donation - refers to a document executed by the donor, under the formalities required by law, evidencing the donation of the property.
i. Certificate of Stewardship - refers to a document awarded to individuals or families actually occupying or tilling portions of forest lands pursuant to LOI 1260 for a period of 25 years’ renewable for another 25 years.
j. Special Land Use Permit (SLUP) - refers to a privilege granted by the State to a person to occupy, possess and manage in consideration of specified return, any public forest lands for a specific use or purpose.
k. Contract of Usufruct - refers to a document which stipulates that DepEd/school is allowed of full use or perpetual right of use of property without consideration as long as the property is used solely for educational or designated
purposes.
l. Memorandum of Agreement or Understanding/Lease Agreement - refers to a document executed by the legal owner/occupant of the land setting unnecessary the conditions on the use of the property.
m. Others - refers to the other documents that are competent proof of ownership and occupancy.
(See continuation of definitions on the next page)
Reminder: In case the school head does not have adequate information on the items listed above, the assistance of the Industrial Arts Teacher/Division Physical Facilities Coordinator/Division Project Engineer can be asked.
Certified True and Correct by: Validated by Phy. Facilities Coordinator/Div. Engineer: Validated by Planning Officer III (PRS-SGOD):
School Head : 0
515377012.xlsx Box8 Page 20 of 48
(Continuation of definitions from previous page, Box 8)
2. Total Land Area - refers to the size in square meters of all areas designated as land used for some particular purpose such as school building.
3. Mode of Acquisition of School Site - refers to the means of acquiring the school site.
a. Donation - includes the four (4) types of donation: .
a.1. Simple Donation - refers to a type of donation whereby a person, through an act of liberality disposes a piece of land in favor of the government.
a.2. Conditional Donation - refers to a type of donation which imposes a condition (e.g., "that the land shall be used only for education"). In such case, the property is reverted to the owner when the condition as stipulated in the
donation is not met.
a.3. Inter Vivos Donation - refers to a type of donation that is in effect during the lifetime of the donor.
a.4. Mortis Causa - refers to a type of donation that takes effect only after the donor's death. Donations by mortis causa should conform to the formalities required of the last will.
b. Purchase - refers to a mode of acquisition of school sites by direct purchase from the legal owner who voluntarily sold it as evidenced by a Deed of Sale duly executed, notarized and registered with the Register of Deeds.
c. Expropriation - refers to a mode of acquisition of school sites by the government through the exercise its power of eminent domain (i.e. by taking private property for public use upon payment of just compensation).
d. Exchange (Land Swapping) - refers to a mode of acquisition of school sites by exchanging an existing school site for a new site for justifiable reasons as identified by law.
e. Presidential Proclamation - refers to a mode of acquisition of school sites by virtue of a declaration by the President under the procedures established by law.
4. Within Ancestral Domain - refers to all areas generally belonging to Indigenous Cultural Communities / Indigenous People (ICCs/IPs) comprising lands, inland waters, coastal areas, and natural resources therein, held under a claim of
ownership, occupied or possessed by ICCs/IPs, communally or individually since time immemorial. It covers the total environment, including the spiritual and cultural bonds to the areas which the ICCs/IPs possess, occupy and use and to
which they have claims of ownership.
a. Certificate of Ancestral Domain Titles (CADT) - refers refers to a title formally recognizing the rights of possession and ownership of ICCs/IPs over their ancestral domains identified and delineated in accordance with RA No. 837
otherwise known as the Indigenous People’s Rights Act of 1973.
5. Within Ancestral Land - refers to occupied land, possessed and utilized by individuals, families and clans who are members of the ICCs/IPs since time immemorial. Ancestral lands include residential lots, rice terraces or paddies, private
forests, swidden farms and tree lots. These may be found within ancestral domains.
a. Certificate of Ancestral Land Title (CALT) - refers to a title formally recognizing the rights of ICCs/IPs over their ancestral lands.
6. Legal Ownership Issues:
a. Adverse Claim - refers to a written statement setting forth claim to the title or right to possession over a registered property, alleging how and under whom such alleged right was acquired.
b. Encroachment - refers to unlawful interference or gaining upon the land, property, other possessions, or the rights of another.
c. With Illegal Settlers - refers to groups of housing units illegally constructed on a land that the occupants have no legal claim.
7. School Site within:
a. Protected Areas – refers to identified portions of land and water set aside by reason of their unique physical and biological significance, managed to enhance biological diversity and protected against destructive human exploitation,
such as National Parks, Natural Parks, Natural Monuments, Protected Landscape, Protected Seascape, Game Refuge and Bird Sanctuaries, Resource Reserves, Managed Resource Protected Areas, Marine Reserves, Watershed Forest
Reserves, Natural Biotic Areas, Wildlife Sanctuaries, and Wilderness Areas.
b. Timberland and Forestland – refers to lands of the public domain which have been the subject of the present system of land classification and determined to be needed for forest purposes. Eventually, these lands will be proclaimed
as forest reserves by the President.
Box 9. SCHOOL LOCATION, SY 2020-2021 (As of October 31, 2020)

Location descriptions for your school: (Check all applicable) Notes: * - facing or directly beside a national road/public road
✘0
Along the highway * 0 On a small island **** 0 Near a faultline ***** ** - on an inclined or steeped area
0 By the hillside ** 0 Near the coastline ***** 0 Others, (specify) *** - on an elevated area
0 On top of a mountain *** 0 Near a river or waterway ***** **** - an island with an area less than 200 sq. km.
***** - near if within 1.5 km from the school
Certified True and Correct by : Validated by Phy. Facilities Coordinator/Div. Engineer: Validated by Planning Officer III (PRS-SGOD):
School Head : 0 0
515377012.xlsx Box8 cont.-Box9 Page 21 of 48
Table 23. HEALTH AND NUTRITION, SY 2020-2021
A. Number of learners who were vaccinated by the Department of Health among the learners
this SY 2020-2021 from August 1 to December 31, 2020 (based on LGU health records)
Grade 1 Grade 4
Type of Vaccines
Male Female TOTAL Female
Measles Containing Vaccine 0
Tetanus Diphtheria 0
Human Papiloma Virus
B. Number of learners who underwent vision screening
Kindergarten Grade 1 Grade 2 Grade 3 TOTAL

Vision Screening Results (Kindergarten to Grade 3)
Male Female Male Female Male Female Male Female Male Female
Passed 0 0
Failed 0 0
TOTAL 0 0 0 0 0 0 0 0 0 0
Note: This table on the number of learners who underwent vision screening does not need to be filled out since face-to-face classes have been suspended.
C. Number of learners by nutritional status

Learners with TOTAL
Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6 Disabilities (Kindergarten to
Nutritional Status (Non-Graded) LWDs Non-Graded)
Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female
Weight
Normal 0 0
Obese 0 0
Overweight 0 0
Severely Wasted 0 0
Wasted 0 0
TOTAL 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Height
Severely Stunted 0 0
Stunted 0 0
Normal 0 0
Tall 0 0
TOTAL 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Learners Nutritional Status in Weight:

1. Normal - refers to a learner with normal weight for his/her age whose BMI-for-age fall between -2 to +2 z-score line or standard deviation (SD).
2. Obese - refers to a learner who is severely overweight for his/her height and whose BMI-for-age fall beyond +3 z-score line or standard deviation (SD).
3. Overweight - refers to a learner weighing too much for his/her height and whose BMI-for-age fall between +2 to +3 z-score line or standard deviation (SD).
4. Severely wasted - refers to a very thin learner whose BMI-for-age is below -3 z-score line or standard deviation (SD).
5. Wasted - refers to a thin learner whose BMI-for-age fall between -2 to -3 z-score line or standard deviation (SD).
Learners Nutritional Status in Height:
1. Severely Stunted - refers to a learner who is very short for his/her age and whose height-for-age (HFA) fall below -3 z-score line or standard deviation (SD).
2. Stunted - refers to a learner who is short for his/her age and whose height-for-age (HFA) fall between -2 to -3 z-score line or standard deviation (SD).
3. Normal - refers to a learner with normal height for his/her age and whose height-for-age (HFA) fall between -2 to +2 z-score line or standard deviation (SD).
4. Tall - refers to a learner who is tall for his/her age and whose height-for-age (HFA) fall beyond +2 z-score line or standard deviation (SD).
Note: This table on the nutritional status of learners does not need to be filled out since the conduct of nutritional assessment has been suspended per DO 23, s. 2020.
Certified True and Correct by: Validated by Division School Health Coordinator/Medical Officer/Nurse: Validated by Planning Officer III (PRS-SGOD):
School Head : 0 0
515377012.xlsx Table23a-c Page 22 of 48

D. Number of learners who were dewormed from August 1 to December 31, 2020 (based on LGU health records)
Learners with TOTAL
Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6 Disabilities (Kindergarten to
(Non-Graded) LWDs Non-Graded)
Number of Learners Dewormed
Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female
0 0
Box 10. SCHOOL CLINIC, SY 2020-2021 (As of December 31, 2020)

1. Does the school have a designated school clinic? ✘0 Yes No
2. Does the school have a designated Clinic Teacher? 0 Yes No
3. How many weighing scales does the school have?
Number of Units
Type of Weighing Scale
Available in the School
Bathroom
Beam balance
Others, (specify
4. Which of the following tools does the school use for taking height?
0 Tape Measure 0 Microtoise 0 Others, (specify)
0 Steel tape 0 Stadiometer
5. How many first aid kits does the school have?
6. How many medical thermometers does the school have?
7. How many blood pressure apparatus does the school have?
8. How many school personnel has a training on basic life support and/or first aid?
Certified True and Correct by: Validated by Division School Health Coordinator/Medical Officer/Nurse:
School Head : 0
0
515377012.xlsx Table23d-Box10 Page 23 of 48

Box 11. AVAILABILITY OF WATER SUPPLY, SY 2020-2021 (As of December 31, 2020)
1. Is there a water source inside the school ground? ✘0 Yes No
If Yes,
1.1. Main Water Supply Source:
0 Piped water from local service provider 0 Rainwater Catchments
0 Water Well 0 Others, (specify)

0 Natural source
1.2. Average Cost of Monthly Bills/Maintenance: (Indicate the amount in PhP)

1.3. Who pays for the Cost of Monthly Bills/Maintenance?
0 School MOOE 0 School Canteen Fund
0 PTA 0 Others, (specify)
1.4. Is the water source inside the school ground being used for drinking? 0 Yes No
1.5. Has the water source inside the school been tested to determine safety of the water? 0 Yes No
1.5.a. If Yes, did the test results show that the water source inside the school is safe to drink? 0 Yes No
1.5.b. How frequent is the water source tested for safety?
0 Monthly 0 Annually
0 Quarterly 0 Others, (specify)
1.5.c. When was the last time the water source was tested?
1.6. Are there times in the year when water is not available for an extended period of time? 0 Yes No
2. Does the school have mechanism to ensure that the learners have safe drinking water? 0 Yes No
2.1. If Yes, what mechanism is used?
0 Teachers ask the learners to bring their own drinking water to school
0 Safe water in refillable containers are provided in designated areas within the school
0 Water from an accessible water source is treated (i.e., boiled, etc.)

0 Others, (specify)
Notes:
1. Local piped water - water source coming from local water service providers.
2. Water well - an excavation structure in the ground by digging, driving, boring or drilling to access water in underground aquifiers.
3. Rainwater catchment - water sourced from rainwater and collected thru a rainwater collector.
4. Natural source - water sourced from a spring or stream that is either located inside the school grounds or located outside school grounds but water is supplied via pipes.
Table 24. NUMBER OF EXISTING WASH FACILITIES, SY 2020-2021 (As of December 31, 2020)
Functional TOTAL Number
Usage Non-Functional Number of Wash of
with soap without soap Facilities Water Outlets
Facilities for group handwashing 0
Facilities for individual handwashing 0
Notes:
1. Group handwashing facility - a facility to be used in supervised handwashing and toothbrushing activtity that can accommodate at least 10 learners.
2. Individual handwashing facility - a facility in the classroom, drinking points, near toilets, near the canteen, etc. that learners can be used for handwashing at critical times.
3. Functional facilities for handwashing - the hand washing facility is accessible, with daily water supply, learner-appropriate height and with appropriate drainage.
4. Non-functional facilities for handwashing - the hand washing facility is broken, clogged or damaged in such a way that it cannot be used.
5. Water Outlet - any opening where water comes out for handwashing (e.g., Faucets, Punch Pipes, etc.).
School Head : 0 0
515377012.xlsx Box11-Table24 Page 24 of 48
Table 25. ORAL HEALTH, PREVIOUS SY 2019-2020
TOTAL
Details Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6 (Kindergarten
to Grade 6)
Number of Learners Examined 0

Decayed, Missing, and Filled Teeth (DMFT) - Permanent Teeth
No. of Learners with DMFT 0
No. of DMFT 0
Decayed, Missing, and Filled Teeth (DMFT) - Temporary Teeth
No. of Learners with DMFT 0
No. of DMFT 0
Number of Learners Found to Have Gum Disease 0
Number of Learners with Other Significant Dental Anomalies 0
Number of Learners who Underwent Flouridization 0
Notes:
1. Decayed, Missing, and Filled Teeth (DMFT) Index - refers to the common method use in oral epidemology for assessing dental carries prevalence as well as dental treatment needs among
populations.
2. Gum Disease - refers to an inflammation of the gum line that can progress to affect the bone that surrounds and supports the teeth.
3. Dental Anomalies - refers to the craniofacial abnormalities of form, function or position of the teeth, bones, and tissues of the jaw and mouth.
4. Fluoridization - refers to the topical application of fluoride compounds onto the tooth surface to reduce the incidence of dental caries.

Table 26. MEDICAL AND NURSING SERVICES, PREVIOUS SY 2019-2020

TOTAL
Details Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6 (Kindergarten
to Grade 6)
Number of Learners Examined 0
Number of Learners with Findings 0

Number of Learners Given Interventions by Clinic Teachers and
0
DepEd Health Personnel
Number of Learners Referred to City/Rural Health Units or Other
0
Private Health Professionals
Table 27. MENTAL HEALTH, For the months of April 2020 to November 2020
(Provide the number of cases of suicide and attempted suicide among learners and school personnel that were recorded by the school during the pandemic)
Number of Cases in Year 2020
Cases Among Learners Among School Personnel
April May June July Aug. Sept. Oct. Nov. April May June July Aug. Sept. Oct. Nov.
Suicide
Attempted Suicide
TOTAL 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
School Head : 0 0
515377012.xlsx Tables25,26,27 Page 25 of 48
Box 12. MENTAL HEALTH, PREVIOUS SY 2019-2020
1. Does the school have a guidance office? ✘ 0 Yes No
2. Is the person in charge of the guidance office a Registered Guidance Counselor? 0 Yes No
3. Number of learners who sought guidance counseling or life coaching from the school’s guidance counselor or guidance advocate:
Grade Level Number of Learners
Kindergarten
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
TOTAL 0
4. Number of cases of suicide and attempted suicide among learners and school personnel that were recorded by the school:
Number of Cases
Cases
Among Learners Among School Personnel
Suicide
Attempted Suicide
TOTAL 0 0
5. Does the school currently use a “screening tool” for identification of learners at risk of
0 Yes No
mental health conditions?
6. Did the school celebrate the National Mental Health Week in October 2019? 0 Yes No
7. Did the school conduct trainings or extra-curricular activities for learners related to any of the topics below? 0 Yes No
If Yes, indicate the number of learners who participated in the activities that covered each of the following topics.
Mental Health and

Addressing Psychosocial Issues
Suicide Psychological
Grade Level the Problem of and Conditions Self-Care Other Topics
Prevention First Aid
Bullying including
Depression
Kindergarten
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
TOTAL 0 0 0 0 0 0
8. Did the school conduct trainings or extra-curricular activities for teachers related to any of the topics below? 0 Yes No
If Yes, indicate the number of teachers who participated in the activities that covered each of the following topics.
Mental Health and

Addressing Psychosocial Issues
Suicide Psychological
Grade Level the Problem of and Conditions Self-Care Other Topics
Prevention First Aid
Bullying including
Depression
Kindergarten
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
TOTAL 0 0 0 0 0 0
Certified True and Correct by : Validated by Division School Health Coordinator/Medical Officer/Nurse:
School Head : 0 0
0
515377012.xlsx Box12 Page 26 of 48
Box 13. CANCER CASES, PREVIOUS SY 2019-2020
1. Cancer Cases among Learners
Number of Learners
Learners with Cancer
Cancer Cases
Cancer Patients Living with Cancer Cancer Survivors Died due to Cancer
(Symptomatic) (Asymptomatic)
Leukemia
Brain and Spinal Cancer
Other Types of Cancer
TOTAL 0 0 0 0
2. Cancer Cases among School Personnel

Number of School Personnel
School Personnel with Cancer
Cancer Cases
Cancer Patients Living with Cancer Cancer Survivors Died due to Cancer
(Symptomatic) (Asymptomatic)
Breast Cancer
Lung Cancer
Other Types of Cancer
TOTAL 0 0 0 0
Notes:
1. Cancer Patients - are those with symptomatic and/or under definitive or palliative treatment.
2. Living with Cancer - are those with microscopic or residual disease, asymptomatic, or with supportive treatment subclinical symptoms on maintenance or supportive treatment.
3. Cancer Survivors - are those who have completed all of their anti-cancer therapy and presently show no signs of disease.

School Head : 0 0
515377012.xlsx Box13 Page 27 of 48

Box 14. ADOLESCENT REPRODUCTIVE HEALTH, PREVIOUS SY 2019-2020
1. Number of Pregnant Learners
On Alternative Delivery Transferred
Grade Level In School Dropped
Mode (ADM) In Out
Grade 4
Grade 5
Grade 6
TOTAL 0 0 0 0 0
2. Number of Impregnator-Learners
On Alternative Delivery Transferred
Grade Level In School Dropped
Mode (ADM) In Out
Grade 4
Grade 5
Grade 6
TOTAL 0 0 0 0 0
3. Does the school have an operational teen center? ✘0 Yes No

4. Number of Learners Reached by Adolescent Reproductive Health Trainings/Activities
Trained as Peer
Educators for
Participated in Screened for ARH Catered to by Teen
Grade Level Adolescent Sexual and Red Cross Youth
HIV/AIDS Training Concerns Centers
Reproductive Health
(ASRH)
Grade 4
Grade 5
Grade 6
TOTAL 0 0 0 0 0
5. Number of Teachers Reached by Adolescent Reproductive Health Trainings/Activities

Trained on Adolescent
Trained on
Health Education and
Grade Level Adolescent Job Aid HIV/AIDS Training
Practical Training
(AJA)
(ADEPT)
Grade 4
Grade 5
Grade 6
TOTAL 0 0 0
School Head : 0 0
515377012.xlsx Box14 Page 28 of 48
Box 15. TOBACCO CONTROL, SY 2020-2021 (As of December 31, 2020)
1. Does the school display the following IEC materials:
1.a. "No Smoking" Signages (EO 26, s.2017, DO 48, s.2016) ✘
0 Yes No
1.b. Poster at the school gate about prohibition of selling of cigarettes within 100 meters from the perimeter of the
0 Yes No
school (EO 26, s.2017)
2. Is there at least one store or shop with in 100 meters from any point of the perimeter of the school that sells:
2.a. Tobacco products (e.g., cigarettes)? 0 Yes No
2.b. Vape or e-cigarettes? 0 Yes No
3. Measures Against Tobacco Industry Interference:

3.a. How many partnerships did the school have from May 2019 to December 2020?
3.b. How many of these partnerships have the proper partnership instrument needed (e.g., service contract,
memorandum of agreement (MOA), deed of donation (DOD)/deed of acceptance, memorandum of
understanding, etc.)?
3.c. How many of the partnerships with memoranda of agreement/deeds of donation include a provision in the
MOA/DOD that the partner/donor is not connected to the tobacco industry, does not received funding from
tobacco companies, or does not sell cigarettes?
Prevalence of the Use of Cigarettes and E-cigarettes/Vapes Among Learners and School Personnel
4.
4.a. Is the school head ____ (Check only one)
0 a tobacco (cigarette) smoker but not an ENDS/ENNDS (vape/e-cigarette) user?
0 an ENDS/ENNDs (vape/e-cigarette) user but not a tobacco (cigarette) smoker?
0 both a tobacco (cigarette) smoker and an ENDS/ENNDS (vape/e-cigarette) user?
0 neither a tobacco (cigarette) smoker nor an ENDS/ENNDS (vape/e-cigarette) user?
4.b. How many teachers are tobacco (cigarette) smokers and/or ENDS/ENNDS (vape/e-cigarette) users?
Number of Teachers
Grade Level Tobacco (Cigarette) Smokers ENDS/ENNDS Tobacco (Cigarette) Smokers and
but are not ENDS/ENNDS (Vape/E-cigarette) Users but are not also ENDS/ENNDS
(Vape/E-cigarette) Users Tobacco (Cigarette) Smokers (Vape/E-cigarette) Users
Kindergarten
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
TOTAL 0 0 0
4.c. In the previous school year, how many learners were recorded by the school to have smoked tobacco and/or used ENDS/ENNDS?
Number of Learners
Grade Level Smoked Tobacco (Cigarette) Used ENDS/ENNDS Smoked Tobacco (Cigarette) and
but not used ENDS/ENNDS (Vape/E-cigarette) but Smoked also Used ENDS/ENNDS
(Vape/E-cigarette) Tobacco (Cigarette) (Vape/E-cigarette)
Kindergarten
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
TOTAL 0 0 0
Note: ENDS/ENNDS - stands for Electronic Nicotine Delivery Systems and Electronic Non-Nicotine Delivery Systems, which include vape and e-cigarettes.
School Head : 0 0
515377012.xlsx Box15 Page 29 of 48

Box 16. NATIONAL PREVENTIVE DRUG EDUCATION, SY 2020-2021 (As of December 31, 2020)
1. Does the school implement a preventive drug education program? ✘ 0 Yes No

2. Which of the following components are part of the school's preventive drug education program?
0 Curriculum integration 0 Partnership with the Barangay Anti-Drug Abuse Council
0 Extra-curricular activities 0 Others, (specify)
3. Does the school have a National Drug Education Program (NDEP) Coordinator? 0 Yes No
4. How many classrooms have NDEP Corners?
Box 17. OK sa DepED PROGRAM, SY 2020-2021 (As of December 31, 2020)

1. Does the school have a designated OK sa DepEd focal person (DO 28, s. 2018)? 0 Yes No
2. In the previous school year, did the school observe “One Health Week” as part of OK sa DepEd? 0 Yes No
3. Does the school officially manage a Facebook page? 0 Yes No
3.a. If Yes, what is the Facebook page address? (facebook.com/________)
Box 18. FEEDING PROGRAM, SY 2020-2021 (As of December 31, 2020)

1. Does the school have a feeding program? 0 Yes No

If Yes, what is the funding source of school feeding program?
0 School MOOE 0 Barangay Fund
0 School Canteen Fund 0 Private Individual/Sector Fund

0 LGU Fund 0 School-Based Feeding Program (SBFP)
0 PTA Fund 0 Others, (specify)
2. Availability of agriculture and fishery resources in the school :

0 Gulayan sa Paaralan, If check, which of the following types of vegetables are present in the school garden?
0 Legumes 0 Leafy vegetables 0 Fruit-bearing 0 Rootcrops
0 Fish Pond
0 Agricultural Crops
0 Livestock
0 Others, (specify)
0 None
3. Does agricultural and fishery in the school used for feeding program? 0 Yes No
If Yes, what is the funding source?
0 School MOOE 0 Barangay Fund
0 School Canteen Fund 0 Private Individual/Sector Fund
0 LGU Fund 0 Others, (specify)
0 PTA Fund
Box 19. FOOD HANDLING, SY 2020-2021 (As of December 31, 2020)

1. Does the school have a canteen? 0 Yes No

If Yes,
1.a. Managed by: 1.b. Sanitary Permit 1.c. Validity Date 1.d. Do canteen personnel/food handlers
have health certificates?
0 School 0 Yes No
0 Teacher-Coop 0 Yes No
0 Others, (specify)
0 Yes No
Note: Sanitary Permit - is the official document issued by proper authorities to an establishment that has been determined to have met the minimum
requirements for the sanitary operation.
Certified True and Correct by : Validated by Division School Health Coordinator/Medical Officer/Nurse:
School Head : 0 0
0
515377012.xlsx Boxes16,17,18,19 Page 30 of 48
Box 20. SOLID WASTE MANAGEMENT, SY 2020-2021 (As of December 31, 2020)
(Check as appropriate)
1. Is your school compliant to the Ecological Solid Waste Management Act (RA 9003)? ✘ 0 Yes No
2. How is the school implementing Solid Waste Management?
0 Composting 0 Posting of signage 0 Use of paper plates/cups instead of plastic
0 Designation of trash collection point 0 Recycling Projects 0 Use of recycled materials are teaching tool
0 Poster making and/or slogan making contest 0 School representative at the Barangay Solid 0 Use of reusable food containerts
Waste Management Committee 0 Waste segregation
3. Who are the school stakeholders actively engaged on the implementation of solid waste management?
0 Barangay 0 Local business partners 0 Parents
0 Community leaders 0 Municipal/City government
Box 21. OPERATION AND MAINTENANCE OF SANITATION FACILITIES, SY 2020-2021 (As of December 31, 2020)
1. How often are the sanitation facilites cleaned? (Check only one)
0 Daily 0 Once a week
0 At least twice a week 0 Less than once a week
1.1. Average Cost of Monthly Bills/Maintenance: (Indicate the amount in Php)

1.2. Who Pays for the Cost of Monthly Bills/Maintenance?
0 School MOOE 0 School Canteen Fund
0 PTA 0 Others, (specify)
Box 22. MENSTRUAL HYGIENE, SY 2020-2021 (As of December 31, 2020)

Does the school have a provision for availability of sanitary pads? 0 Yes No
If Yes, where can the learners avail the sanitary pads?
0 School Canteen 0 Guidance Office
0 School Clinic 0 Others, (specify)
School Head : 0 0
515377012.xlsx Boxes20,21,22 Page 31 of 48
Box 23. CHILD PROTECTION, PREVIOUS SY 2019-2020
1. Does the school have a Child Protection Committee (CPC)? ✘ 0 Yes No
1.a. If Yes, how often does the CPC meet? 0 Monthly 0 Quarterly 0 Annually 0 Others, (specify)
1.b. How many cases were referred to appropriate authority (e.g PNP, LSWDO, NGOs, etc)?
2. Does the school have a Student Code of Conduct? 0 Yes No
Box 24. CHILD PROTECTION: VIOLENCE AGAINST CHILDREN, PREVIOUS SY 2019-2020

1. Number of reported incidents of violence against children committed in schools by type of violence:
Incidents recorded Perpetrator
Types of Violence
Against Male Learners Against Female Learners TOTAL School Personnel Outsider
Physical Violence 0
Sexual Violence 0
Psychological Violence 0
Other Acts of Violence 0
TOTAL 0 0 0 0 0
2. Number of reported incidents of violence against children by grade level and sex
Grade Level Male Female TOTAL
Kindergarten 0
Grade 1 0
Grade 2 0
Grade 3 0
Grade 4 0
Grade 5 0
Grade 6 0
TOTAL 0 0 0
Notes:
1. Violence Against Children - refers to a single act or series of acts committed by school administrators, academic, and non-academic personnel against a child (DO 40 s.2012).
2. Incidents recorded - refers to incidence of violence reported to the school regardless of criminal or admin case filed.
3. Perpetrator - refers to an adult, including any school personnel, teaching or non-teaching.
4. Other Acts of Violence - refers to physical, sexual, or psychological nature that are prejudicial to the child (DO 40 s.2012).
Certified True and Correct by : Validated by Division Child Protection Focal Person/Coordinator: Validated by Planning Officer III (PRS-SGOD):
School Head : 0
515377012.xlsx Boxes23-24 Page 32 of 48
Box 25. CHILD PROTECTION: BULLYING, PREVIOUS SY 2019-2020
1. Number of reported incidents of bullying or peer abuse by type of violence:
Incidents recorded
Types of Bullying
Against Male Learners Against Female Learners TOTAL
Physical Bullying 0
Cyber Bullying 0
Gender-based Bullying 0
Social Bullying 0
TOTAL 0 0 0
2. Number of reported incidents of bullying or peer abuse by grade level and sex
Grade Level Male Female TOTAL

Kindergarten 0
Grade 1 0
Grade 2 0
Grade 3 0
Grade 4 0
Grade 5 0
Grade 6 0
TOTAL 0 0 0
3. Usual reasons for bullying that were recorded by the school

TOTAL
Reasons Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6 (Kindergarten
to Grade 6)
Physical appearance 0
Status in life (e.g. poor) 0
Skin colour 0
Age (young or old) 0
Gender 0
Race or ethnicity 0
Religion 0
Disability 0
Others 0
TOTAL 0 0 0 0 0 0 0 0
Notes:
1. Bullying or peer abuse - refers to any severe, or repeated use by one or more students of a written, verbal or electronic expression, or a physical act or gesture, or any combination thereof, directed at
another student (DO 55 s.2013).
2. Incidents recorded - refers to incidence of bullying reported to the school regardless of criminal or admin case filed.
3. Physical Bullying - refers to any unwanted physical contact between the bully and the victim.
4. Cyber Bullying - refers to any bullying done through using technology or any electronic means (e.g instant messaging, social media, etc).
5. Gender-based Bullying - refers to any act that humiliates or excludes a person on the basis of perceived or actual sexual orientation and gender identity.
6. Social Bullying - refers to any social behaviour intended hurt others or to belittle another individual (e.g verbal, social exclusion).
Certified True and Correct by : Validated by Division Child Protection Focal Person/Coordinator: Validated by Planning Officer III (PRS-SGOD):
School Head : 0 0
515377012.xlsx Box25 Page 33 of 48
Box 26. SCHOOL SPORTS PROGRAM: AVAILABLE SPORTS EVENTS, CLUBS, AND FACILITIES, SY 2020-2021 (As of October 31,2020)
(Check multiple sports events, clubs, and facilities being offered in the school)
Sports Sports Sports Sports Sports Sports
Sports Program Sports Program
Event/s Club/s Facilities Event/s Club/s Facilities
1. Archery 0 0 0 16. Women Artistic Gymnastics (WAG) 0 0 0

✘
2. Arnis 0 0 0 17. Ryhtmic Gymnastics (RG) 0 0 0
3. Athletics (throwing) 0 0 0 18. Pencak Silat 0 0 0
4. Athletics (running) 0 0 0 19. Sepak Takraw 0 0 0
5. Badminton 0 0 0 20. Softball 0 0 0
6. Basketball 0 0 0 21. Swimming 0 0 0
7. Baseball 0 0 0 22. Table Tennis 0 0 0
8. Billards 0 0 0 23. Taekwondo 0 0 0
9. Boxing 0 0 0 24. Tennis 0 0 0
10. Chess 0 0 0 25. Volleyball 0 0 0
11. Dance Sports 0 0 0 26. Wrestling 0 0 0
12. Football 0 0 0 27. Wushu 0 0 0
13. Futsal 0 0 0 28. Bocce 0 0 0
14. Aerobic Gymnastics 0 0 0 29. Goal Ball 0 0 0
15. Men Artistic Gymnastics (MAG) 0 0 0
Notes:
1. Sports events - current sports events being offered by the school.
2. Sports clubs - current sports clubs being offered by the school.
3. Sports facilities - current venues being used for sports events.
Certified True and Correct by: Validated by Division Sports Coordinator: Validated by Planning Officer III (PRS-SGOD):
School Head : 0 0
515377012.xlsx Box26 Page 34 of 48
Table 28. SCHOOL SPORTS PROGRAM: SPORTS PERSONNEL (DepEd Funded), SY 2020-2021 (As of October 31,2020)
Number of
Number of Number of
Number of Non-teaching
Number of PE teacher/s Non PE teacher/s
Sporting Events Officiating personnel with
Coach/es with sports with sports
Official/s sports
specialization specialization
specialization
1. Archery
2. Arnis
3. Athletics (throwing)
4. Athletics (running)
5. Badminton
6. Basketball
7. Baseball
8. Billards
9. Boxing
10. Chess
11. Dance Sports
12. Football
13. Futsal
14. Aerobic Gymnastics
15. Men Artistic Gymnastics (MAG)
16. Women Artistic Gymnastics (WAG)
17. Ryhtmic Gymnastics (RG)
18. Pencak Silat
19. Sepak Takraw
20. Softball
21. Swimming
22. Table Tennis
23. Taekwondo
24. Tennis
25. Volleyball
26. Wrestling
27. Wushu
28. Bocce
29. Goal Ball
Notes:
1. Coaches - identified personnel (DepEd funded) who is qualified/currently handling the identified sporting event.
2. Officiating Officials - identified personnel (DepEd funded) who is qualified/can handle officiating the identified sporting event.
3. PE teachers - identified BSPE personnel (DepEd funded) and their sports specialization.
4. Non PE teachers - identified personnel teaching academics (DepEd funded) and their sports specialization.
5. Non-teaching personnel - identified non academic personnel (DepEd funded) and their sports specialization.
Reminder: PE teacher/s, Non PE teacher/s and Non-teaching personnel may identify multiple sporting events.
Certified True and Correct by: Validated by Division Sports Coordinator: Validated by Planning Officer III (PRS-SGOD):
School Head : 0
Table 29. DISASTERS/CALAMITIES, For the months of June 2019 to May 2020
(Provide the number of times the following hazards occurred in your school and its immediate surroundings)
2019 2020
Disasters/Calamities
June July Aug. Sept. Oct. Nov. Dec. Jan. Feb. Mar. April May
Natural Hazards
Drought
Earthquake
Fire *
Flood
Landslide
Storm Surge
Tropical Cyclones ***
Tsunami
Volcanic Eruption
Human-Induced Hazards
Bomb Threat in School Premises
Bombing in School Premises
Crime against learner/s
Crime against non-teaching personnel
Crime against school head/s
Crime against school property
Crime against teaching personnel
Fire **
Hazardous Materials Incident
(e.g. chemical explosion, chemical spill, oil spill, exposure to
radioactive substances)
Health Threat
(i.e. Dengue, Malaria, Measles, food poisoning, disease outbreak)
Hostage-taking within school premises
Shooting incident within school vicinity
Structural collapse (as a result of engineering failures)
Others, (specify)
Certified True and Correct by: Validated by DRRM Coordinator: Validated by Planning Officer III (PRS-SGOD):
School Head : 0
1. Disaster - A serious disruption of the functioning of a community or a society involving widespread human, material, economic or environmental losses and impacts, which exceeds the ability of the affected
community or society to cope using its own resources.
Source of Definition: UNISDR Terminologies. https://www.unisdr.org/files/7817_UNISDRTerminologyEnglish.pdf
2. Human-Induced Hazards -Are induced entirely or predominantly by human activities and choices that adversely affect other persons. The Sendai Framework for Disaster Risk Reduction 2015-2030
categorized these hazards as one of the following: (a) Environmental hazards may include chemical, natural and biological hazards. They can be created by environmental degradation or physical or chemical
pollution in the air, water and soil. Examples include soil degradation, deforestation, loss of biodiversity, salinization and sea-level rise. (b) Technological hazards originate from technological or industrial
conditions, dangerous procedures, infrastructure failures or specific human activities. Examples include industrial pollution, nuclear radiation, toxic wastes, dam failures, transport accidents, factory explosions,
fires and chemical spills.
While the UNISDR subjects armed conflicts and other situations of social instability to the International Humanitarian Law and National Legislation, the DRRMS classifies these violent incidents as human-
induced.
Source of Definition: Sendai Framework for Disaster Risk Reduction 2015-2030. https://www.unisdr.org/files/43291_sendaiframeworkfordrren.pdf
3. Crime against learners / personnel - Murder / Homicide, Physical Injuries, etc.

Source of Definition:DO No. 23, s. 2014. http://www.deped.gov.ph/wp-content/uploads/2014/04/DO_s2014_023.pdf
4. Crime against school property - Theft, Robbery, Arson, etc.
Source of Definition: DO No. 23, s. 2014. http://www.deped.gov.ph/wp-content/uploads/2014/04/DO_s2014_023.pdf
5. Drought - A long lasting event triggered by a lack of precipitation. It is characterized by a deficiency in water supply that is the result of constantly below average precipitation.
Source of Definition:DO No. 23, s. 2014. Enclosure No. 4: Definition of Terms. http://www.deped.gov.ph/wp-content/uploads/2014/04/DO_s2014_023.pdf
6. Earthquake - A weak to violent shaking of the ground produced by the sudden movement of rock materials below the earth’s surface that originate from the tectonic plate boundary. Tectonic earthquakes are
produced by sudden movement along faults and plate boundaries. Earthquakes induced by rising lava or magma beneath active volcanoes is called volcanic earthquakes.
Source of Definition:DOST-PHIVOLCS: Introduction to Earthquake. https://www.phivolcs.dost.gov.ph/index.php/earthquake/introduction-to-earthquake
7. Fire - Interaction of heat, fuel and oxygen which will result in in a chemical reaction called burning.
* Includes forest or bush fires, or burning as consequence of other natural hazard, such as earthquakes.
** Includes fires due to human negligence, such as electrical wiring failure
Source of Definition:DO No. 23, s. 2014. Enclosure No. 4: Definition of Terms. http://www.deped.gov.ph/wp-content/uploads/2014/04/DO_s2014_023.pdf
8. Flood - A progressive abnormal increase in the elevation of the surface level of streamflow until it reaches a maximum height from which the level slowly drops to what is its normal level. The sequence
described all takes place within a certain period of time.
Source of Definition:DOST-PAGASA Learning Tools: Floods. bagong.pagasa.dost.gov.ph/learning-tools/floods
9. Landslide - A mass movement of rock, soil, and debris down a slope due to gravity. It occurs when the driving force is greater than the resisting force. It is a natural process that occurs in steep slopes. The
movement may range from very slow to rapid. It can affect areas both near and far from the source.
Source of Definition: DOST-PHIVOLCS: Introduction to Landslide. https://www.phivolcs.dost.gov.ph/index.php/landslide/introduction-to-landslide
10. Storm Surge - An abnormal increase in water level in seashores when a storm nears coastal lines caused by strong winds brought by low pressure at the eye wall.
Source of Definition: DOST-PAGASA Learning Tools: Meteorological Terms, Storm Surge. http://bagong.pagasa.dost.gov.ph/learning-tools/meteorological-terms
11. Tropical Cyclones - A non-frontal, synoptic-scale cyclone developing over tropical and sub-tropical waters at any level and having a definitely organized circulation. In other parts of the world, these are
referred to as hurricanes, typhoons or simply tropical cyclones depending on the region.
*** Includes Tropical Depression, Tropical Storm, Severe Tropical Storm, Typhoon, and Super Typhoon
Source of Definition: DOST-PAGASA: About Tropical Cyclones. http://bagong.pagasa.dost.gov.ph/information/about-tropical-cyclone
12. Tsunami - An ocean wave produced by a submarine earthquake, landslide, or volcanic eruption that may reach enormous dimensions and have sufficient energy to travel across entire oceans.
Source of Definition: DOST-PAGASA Learning Tools: Meteorological Terms, Tsunami. http://bagong.pagasa.dost.gov.ph/learning-tools/meteorological-terms
13. Volcanic Eruption - The transport of magma or gases to the Earth's surface, which can be accompanied with tremors and eruptions; and the interaction of magma and water underneath the Earth's surface which
can result in phreatic eruptions
Source of Definition: DOST PHIVOLCS: Introduction to Volcanoes. https://www.phivolcs.dost.gov.ph/index.php/volcano-hazard/introduction-to-volcanoes
515377012.xlsx Table29 cont. Page 37 of 48

Table 30. DISASTERS/CALAMITIES (Human-Induced Hazards - Armed Conflict and Grave Child Rights Violations), For the months of June 2019 to May 2020
2019 2020
1. Armed Conflict
1a. Indicate the number of times the following armed conflict occurred in your school and its immediate surroundings.
Armed conflict incident experienced in the past months
1b. Indicate the number of times the state/non-state actors were involved in the armed conflict incidents.
1b1. State Actors:
Armed Forces of the Philippines (AFP)
Philippine National Police (PNP)
Others, (specify)
1b2. Non-State Actors:

Abu Sayyaf Group (ASG)
Bangsamoro Islamic Freedom Fighters (BIFF)
Communist Party of the Philippines/
New People's Army/
National Democratic Front (CPP-NPA-NDF)
Maute Group
Moro National Liberation Front (MNLF)
Others, (specify)
2. Grave Child Rights Violations
2a. Indicate the number of reports of Grave Child Rights Violations within the school and immediate surroundings that were filed through government channels
Killing and maiming of children

Abduction of children
Attacks against schools or hospitals
Denial of humanitarian access for children
Recruitment or use of children as soldiers
Sexual violence against children
School Head : 0 0
1. Armed conflict - refers to armed confrontations occurring between government forces and one or more armed groups, or between such groups arising in the Philippine territory. These
shall include activities which may lead to, or are undertaken in preparation of armed confrontation or armed violence that put children‘s lives at risk and their rights violated. (R.A. 11188)
- Armed conflict incidents include armed encounters such as the All-Out-War in 2000, the September 2013 Zamboanga Siege, the 2017 Marawi Siege, among others.
Source of Definition: R.A. 11188, or the Special Protection of Children in Situations of Armed Conflict (2017)
1b1. & 1b2. State and/or Non-State Actors - refers to parties involved in non-international armed conflict in which hostilities occur between governmental (state) armed forces and non-
governmental (non-state) armed groups or between such groups only.
Source of Definition: D. Schindler, The Different Types of Armed Conflicts According to the Geneva Conventions and Protocols, RCADI, Vol. 163, 1979-II, p. 147. as cited in
International Committee of the Red Cross (ICRC): "How is the Term "Armed Conflict" Defined in International Humanitarian Law?".
https://www.icrc.org/en/doc/assets/files/other/opinion-paper-armed-conflict.pdf
2. Grave Child Rights Violations - refers to the offenses committed against children that constitute flagrant violations of their human rights and have severe consequences in their lives.
Source of Definition: DepEd Order No. 57, s. 2017 Policy on the Protection of Children in Armed Conflict, based on UN Security Council Resolution Nos. 1539, 1612, 1882, 1998
http://www.deped.gov.ph/wp-content/uploads/2017/11/DO_s2017_057.pdf
Table 31. RESULT OF DISASTER INCIDENCES, For the months of June 2019 to May 2020
2019 2020
Result of Disaster Incidences / Emergencies
Number of Classrooms used as Evacuation Center
Number of Days the Classrooms were used as Evacuation Center
Number of School Days lost due to class suspensions resulting from
natural hazards
human-induced hazards
armed conflict
School Head : 0 0
515377012.xlsx Table30 cont.-Table31 Page 39 of 48
Box 27. ENABLING ENVIRONMENT, For the months of June 2019 to May 2020
(Check the appropriate boxes that correspond to the DRRM / CCA / Peacebuilding initiatives conducted)
1. Adopted / localized existing policies relating to DRRM/CCA/Peacebuilding
Policy No. Title

DRRM-CCA Policies
0 DO 82 s.2010 Reiteration of CCA-DRR at the School Level
0 DO 83 s.2011 Disaster Preparedness in Schools
0 DO 43 s.2012 Guidelines on the Implementation of EO 66 (Suspension of Classes)
0 DO 21 s.2015 DepEd DRRM Information Management and Coordination Protocol
0 DO 23 s.2015 School Watching and Hazard Mapping
0 DO 27 s.2015 Family Earthquake Preparedness
0 DO 37 s.2015 Comprehensive DRRM in Basic Education Framework
0 DO 28 s.2016 Strengthening Fire Safety and Awareness Program
0 DM 221 s.2013 Guidelines on the Protection of Children during Armed Conflict
0 DM 041 s.2015 Implementing Brigada Eskwela 2015
0 DM 069 s.2015 Observance of the National Disaster Consciousness Month 2015
0 DO 32 s.2019 Learners and Schools as Safe Zones of Peace
Child Protection and EiE in Armed Conflict Policies
0 DO 44 s.2005 Declaration of Schools as Zones of Peace
0 DO 57 s.2017 Policy on the Protection of Children in Armed Conflict
0 DM 109 s.2017 Public Manifestation of DepEd’s Declaration of Schools as Zones of Peace
0 DO 40 s.2012 Child Protection Policy
2. 0 Designated School DRRM Coordinator

3. 0 Formed School DRRM Team
4. 0 School DRRM Team have defined roles and responsibilities/ functions
5. 0 Has a comprehensive School DRRM/CCA Plan
6. 0 For conflict affected schools, has a comprehensive School Peacebuilding Plan
7. 0 School DRRM/CCA/Peacebuilding Plan considers the needs of learners with disabilities
8. 0 School DRRM/CCA/Peacebuilding Plan considers indigenous knowledge systems and practices (IKSP)
9. 0 School DRRM/CCA/Peacebuilding Plan is gender sensitive
10. 0 Supreme Pupil Government(SPG)/Supreme Student Government (SSG) led in the school DRRM planning process
11. 0 Integrated DRRM/CCA into the School Improvement Plan (SIP)
12. 0 For conflict affected schools, have integrated Peacebuilding into the SIP
13. 0 DRRM/CCA/Peacebuilding activities are supported by school budget
14. 0 Funding sources for interventions in the aftermath of a disaster or emergency exist and can easily be tapped.
15. 0 Has partnerships that could be tapped to support its DRRM/CCA programs and activities, including those after a disaster
16. 0 Has partnerships that could be tapped to support its Peacebuilding programs and activities, including those after an armed conflict
17. 0 Implemented student-led school watching and hazard mapping (DO 23, s 2015)
18. 0 Student-led school watching and hazard mapping made use of hazard maps of PHIVOLCS, MGB, PAGASA and LGUs
19. 0 Results of school watching and hazard mapping is presented and submitted to the school planning team
20. 0 Learners including those with disabilities, IPs, Muslim, and others participated in risk assessment and DRRM planning
21. 0 Incorporated results of student-led school watching and hazard mapping in the School DRRM/CAA/Peacebuilding Plan and SIP
22. 0 School Planning Team have linked the results of the school watching and hazarding mapping with the school's education data to
better understand its risk
23. 0 Submitted Rapid Assessment of Damage Report (RADAR) to the DRRMS Central Office, within 72 hours after the onslaught of a
hazard in the area, if affected by disaster
24. 0 School carries out monitoring and evaluation to assess sustainable implementation
25. 0 Data collection and consolidation of programs and activities on DRRM/CCA/Peacebuilding to monitor results and impacts
School Head : 0 0
515377012.xlsx Box27 Page 40 of 48

(Continuation from previous page, Box 27)
1. CCA (Climate Change Adaptation) - Climate change refers to a change in the state of the climate that can be identified (e.g., by using statistical tests) by changes in the mean
and/or the variability of its properties and that persists for an extended period, typically decades or longer. Adaptation is adjustment in natural or human systems in response to
actual or expected stimuli or their effects, which moderates harm or exploits benefit opportunities (IPCC)*.
Change of climate which is attributed directly or indirectly to human activity that alters the composition of the global atmosphere and which is in addition to natural climate
variability observed over comparable time periods. Adjustments in ecological, social, or economic systems in response to actual or expected climatic stimuli and their effects or
impacts. It refers to changes in processes, practices, and structures to moderate potential damages or to benefit from opportunities associated with climate change (UNFCCC)**.
*Intergovernmental Panel on Climate Change (IPCC)
**United Nations Framework Convention on Climate Change (UNFCCC)
2. DRRM (Disaster Risk Reduction and Management) - is the systemic process of using administrative directives, organizations, and operational skills and capacities to implement
strategies, policies, and improved coping capacities in order to lessen the adverse impacts of hazards and the possibility of a disaster.
Source of Definition: DepEd Order No. 37, s. 2015 The Comprehensive Disaster Risk Reduction and Management in Education Framework. http://www.deped.gov.ph/wp-
content/uploads/2015/08/DO_s2015_37.pdf
3. EiE (Education in Emergencies) - refers to the quality learning opportunities for all ages in situations of crisis, including early childhood development, primary, secondary, non-
formal, technical, vocational, higher and adult education. Education in emergencies provides physical, psychosocial and cognitive protection that can sustain and save lives.
Source of Definition : International Network for Education in Emergencies Term Bank. https://toolkit.ineesite.org/term-bank/en/terms/education_in_emergencies
4. Peacebuilding - refers to a process that facilitates the establishment of durable peace and tries to prevent the recurrence of violence by addressing root causes and effects of
conflict through reconciliation, institution building, and political as well as economic transformation. This consists of a set of physical, social, and structural initiatives that are
often an integral part of post-conflict reconstruction and rehabilitation.
Source of Definition: UNICEF Technical Notes on Conflict Sensitivity and Peacebuilding.
http://www.unicefinemergencies.com/downloads/eresource/docs/KRR/UNICEF%20Technical%20Note%20on%20Conflict%20Sensitivity%20and%20Peacebuilding.pdf
Box 28. SAFE LEARNING FACILITIES, For the months of June 2019 to May 2020
Instructional Non-Instructional Ancillary Facilities

1. Number of classrooms with risk assessment:
2. Number of unsafe classrooms identified:
3. 0 School facilities are sensitive to the needs of persons with disability. (ramps, etc.)
4. 0 School conducts regular inspection of school facilities.
5. Months the maintenance of facilities undertaken.
2019 2020
0 0 0 0 0 0 0 0 0 0 0 0
6. 0✘ School Head has allotted budget for routine maintenance of school building and ancillary facilities.
7. 0 Undertaken regular repair of damaged school building and ancillary facilities
8. 0 There is an ongoing construction in the school.
9. 0 School Head is involved in the quality assurance of the ongoing construction.
10. 0 School Head monitors the progress of the ongoing construction.
11. Guidance and regulations on DO 40 s. 2014 are followed:
0 Safe school building site selection for construction 0 Resilient design 0 Resilient construction
12. 0 Safety precautions are in place for all new and ongoing building construction (e.g. fencing, signages, access).
13. 0 Access of laborers are limited to the construction site only (e.g. temporary bunk houses, separate entry and exit points, own meters for
water and electricity).
14. 0 School Head has a copy of the building plans from the contractor?
Notes:
1. Ancillary - refers to a group of buildings having a secondary or dependent use, such as an annex.
Source of Definition: DepEd Educational Facilities Manual
2. Instructional - these spaces are designed to directly accommodate the educational program. The basic instructional spaces for elementary schools are classrooms and work
education shops or multi-purpose buildings for Home Economics and Industrial Arts Classes. However, for secondary schools offering general curriculum, the basic instructional
spaces are classrooms, computer rooms, science laboratories, and Technology and Livelihood Education (TLE) shops. In secondary vocational schools, basic instructional spaces
also include specialized shops. Other spaces such as libraries, learning centers, gymnasiums, and similar spaces are classified as instructional spaces when they are used directly in
conjunction with the curriculum. In line with the changing curriculum, a modular type of school building has been designed to include components for home economics, industrial
arts, agricultural arts, etc. in one building unit known as multipurpose workshop building.
3. Non-instructional - refers to administrative and non-programmed spaces within the school.

4. Risk Assessment - this process includes identification of the hazards present in the location and an assessment of their potential impacts and effects on the built environment based
on existing or anticipated vulnerabilities and potential losses.
5. Unsafe Classroom - refers to classrooms that have one or a combination of hazards listed in the School Watching Checklist.
Source of Definition: DO No. 23, s. 2015 Student-led School Watching and Hazard Mapping
School Head : 0 0
515377012.xlsx Box27 cont.-Box28 Page 41 of 48

Box 29. SCHOOL DISASTER MANAGEMENT, For the months of June 2019 to May 2020
1. Has a specific Contingency Plan for the hazard/s the school is affected with:
Natural Hazards: Human-Induced Hazards:
0
✘
Drought 0 Flood 0 Tsunami 0 Armed Conflict 0 Fire
0 Earthquake 0 Landslide 0 Volcanic Eruption 0 Bomb Threats / Bombing 0 Others, (specify)
0 Fire 0 Tropical Cyclone 0 Civilian Violence
2. 0 Has an evacuation plan and procedures
3. 0 Has a student-family reunification plan that is clearly disseminated to learners, teachers and parents
4. School DRRM Planning and Contingency Planning are conducted together with the following:
0 Learners 0 LGUs 0 Parents 0 Partners 0 Personnel
5. 0 School is identified as an evacuation center
6. 0 School Head has identified school building and ancillary facilities to be used as temporary evacuation centers for disasters
7. 0 School Head is aware and knowledgeable of the Joint Memorandum Circular No. 1, series of 2013 and RA 10821 and its corresponding IRR, which
stipulates the limited use of schools as evacuation center and the roles of the LGU and DSWD in Camp Management
8. 0
School has documented MoU/MoA with the LGU and DSWD for the use of the school as evacuation center following the JMC 1 s. 2013 and
RA 10821
9. Number of emergency supplies and equipment available in the schools:
2-fold Stretcher First Aid Kit Safety Hat / Helmet
C-Collar Go bag with Multi-Tool for each learner Safety Shoes
Emergency Head Lamp Go bag with Multi-Tool for each personnel Spine Board with Safety Belts
Emergency lights/ flashlights Handheld/Base Radios Splinter
Emergency Whistle Life Vest / Life Jacket Universal Head Immobilizer
Fire Extinguisher Safety Coat
10. School has pre-identified spaces for putting up:
0 Temporary Learning Spaces (TLS) 0 WASH Facilities
11. 0 Conducted training for teaching and non-teaching staff to administer first aid to learners and other personnel
12. 0 School has psychosocial interventions for learners and personnel
13. 0 School has existing resumption strategies and alternative delivery modes to ensure education continuity
14. 0 School has implemented these strategies after disasters resulting from natural hazards
15. 0 School has implemented these strategies during emergencies resulting from armed conflict
16. Resumption strategies the school has implemented and number of days:
Strategies/Alternative Delivery Modes No. of days
0 E-Impact
0 Make-up classes
0 MISOSA
0 Open High School
0 Others, (specify)
17. 0 Ensured that learners completed the Family Earthquake Preparedness Plan (DO No. 27, s. 2015); and school has reported completion to DepEd
DRRMS at the Central Office
18. 0 Presented Family Earthquake Preparedness Plan results to the PTA and LGU
19. 0 School has taken appropriate actions based on the results of the Family Earthquake Preparedness Plan
20. 0 Established a system in tracking learners and personnel in the event of a disaster
21. 0 Conducted Brigada Eskwela to ensure school safety and that disaster preparedness measures are in place
22. 0 Learners, teachers, parents and other stakeholders participated in DRRM, CCA, and Peacebuilding activities
23. 0 School has a functional early warning system to inform learners and personnel of emergencies
(e.g. protocol, warning signs, devices, IEC), with consideration of existing national and LGU warning systems and protocols
24. 0
Conducted regular hazard-specific drills (at least 3 priority hazards based on risk assessment) with the participation of key stakeholders
(e.g. BFP, Medic, LGUs, NGOs, community, PTA, alumni, and others)
25. Number of learners who participated in the following drills in the appropriate month/s:
2019 2020
Types of Drills
Earthquake Drill
Fire Drill
Flood Evacuation Drill
Tsunami Drill
Storm Surge Drill
Lockdown Drill
26. 0 Ensured the participation of children, PWDs, pregnant woman and elderly people during the drills
27. 0 Conducted awareness and capacity building for learners and families
28. 0 School participated in the different DRRM/CCA/Peacebuilding activities of the LGUs
School Head : 0 0
515377012.xlsx Box29 Page 42 of 48
(Continuation from previous page, Box 29)
1. Bomb Threats / Bombing - refers to a threat or actual detonation of an explosive or incendiary device to cause property damage, death, or injuries.
Indiana University: Emergency Planning
https://protect.iu.edu/emergency-planning/procedures/bomb-threats.html
2. Civilian Violence - refers to the use of physical force brought by a noncombatant person, so as to injure, abuse, damage, or destroy. This includes crimes against school
heads, teachers, learners, and school property.
Merriam-Webster Dictionary
https://www.merriam-webster.com/dictionary/violence
3. Contingency Plan - a management process that analyses specific potential events or emerging situations that might threaten society or the environment and establishes
arrangements in advance to enable timely, effective and appropriate responses to such events and situations.
UNISDR Terminologies. https://www.unisdr.org/files/7817_UNISDRTerminologyEnglish.pdf
4. E-Impact - the Enhanced Instructional Management by Parents, Community and Teachers (e-IMPACT) learning system is a technology-enhanced alternative delivery mode
developed by the SEAMEO Regional Center for Educational Innovation and Technology (INNOTECH) to address issues in accessibility and quality of education in schools
usually handled by a few teachers teaching multigrade classes.
UNICEF Evaluation on Alternative Delivery Modes. https://www.unicef.org/evaldatabase/files/Philippines_ADM_Evaluationl_Philippines-2012-001.pdf
5. Evacuation Center - refers to a safe site, building or center hosting internally displaced persons, which includes covered courts, barangay or community halls, camping
areas, collective centers, multi-purpose centers, established “tent cities” or schools.
DSWD-DILG-DOH-DepEd- Joint Memorandum No. 1, S. 2013 on the Guidelines on Evacuation Center Coordination and Management, Part III.
6. Lockdown Drill - An emergency procedure intended to secure and protect occupants who are in the proximity of an immediate threat. This procedure is used when it may be
more dangerous to evacuate a building than stay inside. By controlling entry/ exit and movement within a facility, emergency personnel are better able to contain and handle
any threats.
University of British Columbia: Emergency Procedures. https://emergency.ok.ubc.ca/procedures/lockdown/
7. MISOSA - Modified In-School, Off-School Approach. MISOSA aims to: (i) solve congestion in schools with big enrolment; (ii) address the need of children for adequate
learning materials; (iii) mobilize and strengthen community support; and (iv) improve students’ performance.
UNICEF Evaluation on Alternative Delivery Modes. https://www.unicef.org/evaldatabase/files/Philippines_ADM_Evaluationl_Philippines-2012-001.pdf
8. Open High School - an alternative mode of delivering secondary education for both public and private schools. It puts premium on independent, self-pacing and flexible
study to reach learners who are unable to start or complete secondary education due to problems of time, distance, physical impairment, financial difficulties, social or family
problems.
DepEd Order No. 46, s. 2006 Guidelines on the Implementation of the Open High School Program. http://www.deped.gov.ph/wp-
content/uploads/2006/11/DO_s2006_46.pdf
9. Temporary Learning Spaces - refers to spaces or structures that is established in transitional sites, permanent relocation sites, or in damaged schools, which is intended for
the immediate resumption of formal and non-formal education to ensure continuity of learning of children while awaiting the construction or repair of permanent classrooms.
This includes space for supervised neighborhood play services for preschoolers and learning activities for school-aged children.
Implementing Rules and Regulation (IRR) of RA 10821 “Children’s Emergency Relief and Protection Act”.
10. WASH - Water, Sanitation, and Hygiene Facilities.
515377012.xlsx Box29 cont. Page 43 of 48

Box 30. DISASTER RISK REDUCTION IN EDUCATION, For the months of June 2019 to May 2020
1. School teaches DRRM/CCA and Peacebuilding-related concepts

DRRM/CCA Peacebuilding
Subjects
Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6 Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6
Science 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Araling Panlipunan 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Edukasyon sa Pagpapakatao (EsP) 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Physical Education 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Health 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Edukasyong Pantahanan at Pangkabuhayan (EPP) 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Others 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2. Number of teachers trained in integrating Peace Education in their daily learning log
3. ✘0 DRRM/CCA/Peacebuilding related topics are integrated in SpEd program
4. 0 Learning resources (Teachers Guides and Textbooks/Learning Materials and other supplemental materials) are available to aid teaching DRRM, CCA, and Peacebuilding
5. 0 Skills and competencies of learners are assessed through measurable learning and risk reduction (RR) outcomes
6. Specific activities relating to DRRM, CCA and Peacebuilding with the number of learners who participated
DRRM CCA Peacebuilding
School Activities No. of Learners School Activities No. of Learners School Activities No. of Learners
School Watching and Hazard Mapping Gulayan sa Paaralan Peace Conferences or Camps
Family Earthquake Preparedness Installation of Materials Recovery Facility Creation of youth networks or organizations
Fire Drill Solid Waste Management for peace
Earthquake Drill Recycling Art, essay, slogan, etc. contests for peace
Tsunami Drill Tree Planting
Celebration and commemoration of special
Lockdown Drill National Global Warming and Climate Change events related to peace and human rights
Basic First Aid Conciousness Week (November 19-25)
Other related activities, (specify) Other related activities, (specify) Other related activities, (specify)
School Head : 0 0
515377012.xlsx Box30 Page 44 of 48

Table 32. DISASTER RISK REDUCTION IN EDUCATION (DRRM, CCA, and Peacebuilding Trainings), For the months of June 2019 to May 2020
(Provide the number of personnel who have attended any Disaster Risk Reduction in Education initiatives or trainings)
Number of Nationally-Funded Number of Locally-Funded
DRRM, CCA, and Peacebuilding Trainings Teaching Personnel Non-Teaching Personnel Teaching Personnel Non-Teaching Personnel
Male Female Male Female Male Female Male Female
1. DRRM and Climate Change Terminologies
2. International and National Foundations of DRRM in the Education Sector

3. The Comprehensive Disaster Risk Reduction and Management in Education
Framework and Other DRRM-CCAM Related Policies
4. Inclusive and Child-centered DRRM
5. Education in Emergencies (EiE)
6. Alternative Delivery Modes
7. Information Management
8. School-Based DRRM
9. Camp Management Guidelines for DepEd
10. Temporary Learning Spaces (TLS)
11. Basic Education in Emergencies (EiE) Supplies and Logistics
12. Resource Mobilization and Partnership
13. Contingency Planning for Basic Education
14. Understanding Common Hazards
15. DRRM Mainstreaming in the Planning Cycle
16. Understanding Climate Change
17. Climate Change Global, National and Local Frameworks
18. Understanding Peace and Conflict
19. Conflict Sensitive Education
20. Psychological First Aid
21. Basic Life Support and Occupational First Aid
22. Staff Safety and Security in the Field
23. Other related activities, (specify)
Notes:
Psychological First Aid - An evidence-informed modular approach to help children, adolescents, adults, and families in the immediate aftermath of disaster and terrorism. Individuals affected by a disaster or
traumatic incident, whether survivors, witnesses, or responders to such events, may struggle with or face new challenges following the event. PFA was developed by the National Child Traumatic Stress Network
and the National Center for PTSD, with contributions from individuals involved in disaster research and response.
National Child Traumatic Stress Network: Psychological First Aid
https://www.nctsn.org/treatments-and-practices/psychological-first-aid-and-skills-for-psychological-recovery/about-pfa
School Head : 0 0
Box 31. DISASTER RISK REDUCTION IN EDUCATION
(Information, Education and Communication (IEC) Materials), For the months of June 2019 to May 2020
1. Number of available Information, Education and Communication (IEC) Materials
No. of Available
Disasters/Calamities
IEC Material/s
Natural Hazards
Drought
Earthquake
Fire
Flood
Landslide
Tropical Cyclone
Tsunami
Volcanic Eruption
Armed Conflict
Bomb Threats / Bombing
Civilian Violence
Fire
Other related activities, (specify)
2. ✘0 Presence of DRR/CCA/Peacebuilding corners, with updated IEC materials posted in it, in every classroom
Certified True and Correct by : Validated by DRRM Coordinator:

School Head : 0 0
0
515377012.xlsx Box31 Page 46 of 48

Box 32. ARMED-CONFLICT RELATED INITIATIVES, For the months of June 2019 to May 2020
1. ✘0 Has a lockdown protocol (only for conflict/civilian violence/bomb threat-affected schools)?
2. 0 Has the school been declared as a "Zone of Peace"?
3. Year the school declared as a Zone of Peace

4. Declaration been formalized through a written agreement or code of conduct signed by duly recognized
representatives of stakeholders.
Check the appropriate stakeholders:
0 Armed Forces of the Philippines (AFP)
0 Philippine National Police (PNP)
0 Local Government Unit (LGU)
0 Non-State Armed Group
0 Others, (specify)
5. Activities conducted in relation to the school being a Zone of Peace.
0 Setting-up of Peace Corners
0 Peace conferences or camps
0 Creation of or membership in youth networks or organizations for peace
0 Art, essay, slogan, etc. contests for peace
0 Celebration and commemoration of special events related to peace and human rights
0 Learning and development interventions (e.g. training on conflict resolution and mediation, conflict
analysis, conflict sensitivity)
0 Inter-faith dialogues
0 Community dialogues
0 Others, (specify)
Notes:
Schools as Zones of Peace
- A site with sacred, religious, historic, educational, cultural, geographical, or environmental importance which is protected
and preserved by its own community and officially recognized by a governmental authority
Safe Schools Declaration
- SZOP is one approach UNICEF and partners are using to protect the right of children to access school in conflict- and
crisis-affected areas and to ensure education is not hampered by violence. It parallels the education sector’s broader work to
support efforts to better predict, prevent and prepare for crises. The aim is to improve the quality of the education response
in emergencies and transitions and to use the education system to foster a culture of peace and human rights. Schools are a
key entry point for peace advocacy, and also utilize development of “codes of conduct” to prevent impediments to child
access to school. In addition to advocacy, SZOP incorporates diverse programming at the school, village and district levels.
SZOP programming builds on UNICEF’s ongoing efforts to develop holistic schools, in particular through the Child-
Friendly Schools Initiative and the roll-out of the Quality Education Resource Package.
UNICEF Technical Notes on Conflict Sensitivity and Peacebuilding
http://www.unicefinemergencies.com/downloads/eresource/docs/KRR/UNICEF%20Technical%20Note%20on
%20Conflict%20Sensitivity%20and%20Peacebuilding.pdf
- Refers to demarcated spaces for teachers and students to conduct teaching and learning when they can't do so in their
school because of displacement or damage/destruction of the school. TLSs can and should be established quickly, yet they
also lay a foundation for restarting formal education and enrolling children who were previously out of school. TLSs can
also be used as an entry point for protection, nutrition and health services, and to develop communication channels with
affected populations.
UN OCHA: Humanitarian Response
https://www.humanitarianresponse.info/en/operations/south-sudan/document/education-cluster-standards-tlss
Certified True and Correct by : Validated by DRRM Coordinator:

School Head : 0 0
0
515377012.xlsx Box32 Page 47 of 48
Box 33. INDIGENOUS PEOPLES EDUCATION (IPEd) PROGRAM, SY 2020-2021 (As of October 31, 2020)
1. Check if the school has the following conditions:

0 Peace and order tensions in the community experienced at least once in the past five years caused by the presence of armed groups and/or potential violence; areas that have
✘
experienced worse, like armed conflict or evacuation in the past 5 years are included
0 Cannot be reached by regular cars or through regular public utility vehicles (PUVs; jeep, bus, tricycle); specialized transportation (e.g., single motor or habal-habal, skylab, horse,
bangka) and/or walking is needed
0 Occasional dangerous geographical challenges affecting learners coming to school (e.g., river to be crossed by learners swells during rains; area to school or of the school prone to
landslides)
2. If there is check in any of the above conditions, provide answers to the following:
2.a. Number of teachers residing within and outside the school municipality
Number of Teachers
TOTAL
Teachers Residence Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6 (Kindergarten
to Grade 6)
Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female
Within the School Municipality 0 0
Outside the School Municipality 0 0
TOTAL 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2.b. Does the school have experience in working with the IP community for the development of contextualized lesson plans,
development of learning resources and other activities? 0 Yes No
Reminder: Teachers shall be counted only once. If a teacher is teaching more than one grade, he/she shall be counted to the grade level where he/she teaches the most number of hours.
However, if he/she teaches an equal number of hours per grade level, he/she shall be counted to the highest grade level assignment.
Certified True and Correct by : Validated by Division IPEd Focal Person/Coordinator:

School Head : 0
Validated by Division HR Personnel: Validated by Planning Officer III (PRS-SGOD):

0
(Signature Over Printed Name) 0
Position Title : 0
515377012.xlsx Box33 Page 48 of 48

Government Elementary School Profile, Sy 2020-2021: Status Div. In-Charge

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GOVERNMENT ELEMENTARY SCHOOL PROFILE, SY 2020-2021 STATUS DIV.

1 SCHOOL INFORMATION Revised PRS SGOD & SDO

Republic of the Philippines

GOVERNMENT ELEMENTARY SCHOOL PROFILE

School Name : Region :

Address : Telephone Number :

Date Established (Year) :

0 a SPED Center 0 Grades 1 to 6

0 with SPED Classes/Programs

0 an Annex/Extension School (Indicate Mother School ID: )

2. Special Science Elementary School (SSES) 0 0

With Diagnosis from Licensed Medical Specialist:

5. Autism Spectrum Disorder 0 0 0 0 0 0

10. Special Health Problem/Chronic Disease 0 0 0 0 0 0

11. Multiple Disabilities 0 0 0 0 0 0

3. Difficulty in Applying Knowledge 0 0 0

5. Difficulty in Applying Adaptive Skills 0 0 0

6. Difficulty in Displaying Inter-Personal Behavior 0 0 0

515377012.xlsx Table1-2 Page 2 of 48

Classification of Learners with Disabilities:

LWDs With Diagnosis from Licensed Medical Specialist:

LWDs With Manifestations:

Types of Devices Number of Devices

A. ASSISTIVE TECHNOLOGY DEVICES Notes:

5 Bluetooth Hearing Aid

10 Braille Translation Software

11 Chair with Writing Board

18 Head Mouse & Eye Trackers

20 Job Access with Speech (JAWS)

22 Microsoft Screen Magnifier

24 One Touch Magic Screen

25 Remote Control with enlarged Buttons

1 Big Bubbles Kit

3 First Aid Kit

5 Safety Wall Mirror

515377012.xlsx Table3 Page 4 o f 48

4 Cross Cut Saw

19 Portable Electric Drill

Reminder: Table 4 shall be accomplished ONLY by Elementary Schools and SPED

Certified True and Correct by: Validated by Division SPED Coordinator:

Position Title : 0 Position Title : 0

Validated by Planning Officer III (PRS-SGOD):

515377012.xlsx Table4 Page 5 of 48

With Diagnosis from Licensed Medical Specialist: Notes:

5. Autism Spectrum Diaorder

8. Speech /Language Disorder

10. Special Health Problem/Chronic Disease

11. Multiple Disabilities

Large Print Font 17

Large Print Font 18

Large Print Font 22

Large Print Font 27

Large Print Font 29

Large Print Font 30

Goal Ball Goal Ball - is a sport equipment use in paragames.

515377012.xlsx Table5 Page 6 of 48

ASD/ EBD/ Two (2) or

Master Teacher III

515377012.xlsx Table6 Page 7 of 48