Page 1

BADAC DATA CAPTURE FORM 1

INDICATOR POSITION FIRST NAME LAST NAME SEX BIRTHDATE CIVIL STATUS ADDRESS CONTACT #
Chairperson / BRGY. SAN ISIDRO, PALOMPON,
IAN JAY AREVALO M 11-28-1972 MARRIED LEYTE 09178539101
Punong Barangay
Vice-Chairperson /
BRGY. SAN ISIDRO, PALOMPON,
Peace & Order ARTURO VIVERO M 07-11-1944 MARRIED LEYTE 09358568480
Committee Chair
Members:
Chair of Women
BRGY. SAN ISIDRO, PALOMPON,
& Family CONCEPCION MONTERO F 01-18-1956 MARRIED LEYTE 09265336990
Committee
BRGY. SAN ISIDRO, PALOMPON,
BADAC is SK Chairperson LIZA MARIE MANINGO F 11-24-1998 SINGLE LEYTE 09682598450
composed of
School Principal / LINCOLN ST. BARANGAY CENTRAL
seven (7) RUBEN NICOL M 10-18-1966 MARRIED II, PALOMPON, LEYTE 09455593956
Representative
members
BRGY. SAN ISIDRO, PALOMPON,
Brgy Chief Tanod ROBERTO ARCENAL M 02-14-1970 MARRIED LEYTE 09978637190
NGO / CSO BRGY. SAN ISIDRO, PALOMPON,
MARVIN VERANO M 7/5/1993 MARRIED LEYTE 09368223423
Representative
Faith-based Org BRGY. SAN ISIDRO, PALOMPON,
CHARO SON F 04-07-1976 MARRIED LEYTE 09772691607
Representative
Adviser:
Local PNP
Chief / PMAJ. AMBROCIO DEMAIN
Representative
Chairperson / Peace
BRGY. SAN ISIDRO, PALOMPON,
& Order Committee ARTURO VIVERO M 07-11-1944 MARRIED LEYTE 09358568480
BADAC Chair
Committee on Members:
Operations is BRGY. SAN ISIDRO, PALOMPON,
organized Brgy Chief Tanod ROBERTO ARCENAL M 02-14-1970 MARRIED LEYTE 09978637190
BADAC Auxiliary
Refer to BADAC Auxiliary Team Profile
Team
Chairperson /
BRGY. SAN ISIDRO, PALOMPON,
Women & Family CONCEPCION MONTERO F 01-18-1956 MARRIED LEYTE 09265336990
Committee Chair
Members:
BADAC SK Chairperson LIZA MARIE MANINGO F 11-24-1998 SINGLE
BRGY. SAN ISIDRO, PALOMPON,
09682598450
Committee on LEYTE
Advocacy is School Principal / LINCOLN ST. BARANGAY CENTRAL
RUBEN NICOL M Oct-18 MARRIED II, PALOMPON, LEYTE 09455593956
organized Representative
NGO / CSO BRGY. SAN ISIDRO, PALOMPON,
MARVIN VERANO M 7/5/1993 MARRIED LEYTE 09368223423
Representative
 organized

Faith-based Org BRGY. SAN ISIDRO, PALOMPON,

CHARO SON F 04-07-1976 MARRIED LEYTE 09772691607
Representative

Page 2
BADAC DATA CAPTURE FORM 1

INDICATOR POSITION FIRST NAME LAST NAME SEX BIRTH DATE CIVIL STATUS ADDRESS CONTACT #
BRGY. SAN ISIDRO, PALOMPON,
BADAC OFFICER BRIAN GORUMBA M MARRIED LEYTE 09950676124
BRGY. CHIEF BRGY. SAN ISIDRO, PALOMPON,
ROBERTO ARCENAL M 02-14-1970 MARRIED LEYTE 09978637190
TANOD
BRGY. SAN ISIDRO, PALOMPON,
BRGY. TANOD EDWIN ESTABILLO M 01-26-1977 SINGLE LEYTE 09630743635
BRGY. SAN ISIDRO, PALOMPON,
DENNIS CUSTADO M 11-25-1991 SINGLE LEYTE 09750760880
BRGY. SAN ISIDRO, PALOMPON,
RODEL EDRADAN M 09-174-1983 MARRIED LEYTE 09651278409
BRGY. SAN ISIDRO, PALOMPON,
MARK DAMAYO M 03-28-1994 SINGLE LEYTE 09502456576
BRGY. SAN ISIDRO, PALOMPON,
GREGORIO MAÑANITA M 1/5/1971 WIDOWER LEYTE NONE
BRGY. SAN ISIDRO, PALOMPON,
JESSA ESPINOSA F 12-25-1989 MARRIED LEYTE 09265280584
BRGY. SAN ISIDRO, PALOMPON,
CRISPIN SINGSON M 10-25-1966 MARRIED LEYTE NONE
BRGY. SAN ISIDRO, PALOMPON,
ELMER RIVERA M 10/7/1982 MARRIED LEYTE 09317428239
BRGY. SAN ISIDRO, PALOMPON,
RENE MOLLEJON M 08-13-1972 MARRIED LEYTE NONE
BRGY. SAN ISIDRO, PALOMPON,
WINIFREDO PAÑAS M 04-29-1976 MARRIED LEYTE 09533503400
BADAC
Auxiliary Team BRGY. SAN ISIDRO, PALOMPON,
ROGELIO CATALOGO M 6/4/1948 MARRIED LEYTE 09368412256
(BAT) is
organized BRGY. SAN ISIDRO, PALOMPON,
DOMINGO JORDA M 06-13-1971 MARRIED LEYTE NONE
BRGY. SAN ISIDRO, PALOMPON,
RONNIE SANCHEZ M 4/12/1982 MARRIED LEYTE NONE
BRGY. SAN ISIDRO, PALOMPON,
WILLIAM GINDAP M 01-20-1989 SINGLE LEYTE 09634757749
BRGY. SAN ISIDRO, PALOMPON,
JASON DOSOL M 12-25-1989 SINGLE LEYTE 09268757046
BRGY. SAN ISIDRO, PALOMPON,
MARCIAL ARCENAL M 09-13-1979 SINGLE LEYTE NONE
BRGY. SAN ISIDRO, PALOMPON,
HURRY SMITH SANACO M 9/5/1983 SINGLE LEYTE 09531274917
 BRGY. SAN ISIDRO, PALOMPON,
CHRIS EVERT DIGNOS M 2/3/1980 MARRIED LEYTE 09173144263
BRGY. SAN ISIDRO, PALOMPON,
AGOSTO ROGANDO M 08-21-1973 MARRIED LEYTE 09753428980
BRGY. SAN ISIDRO, PALOMPON,
JESUS SANCHEZ M 04-17-1976 MARRIED LEYTE 09675487229
BRGY. SAN ISIDRO, PALOMPON,
WILFREDO CALOB M 10/8/1965 MARRIED LEYTE NONE
BRGY. SAN ISIDRO, PALOMPON,
FRANKLIN DIGNOS M 07-27-1974 MARRIED LEYTE NONE
BRGY. SAN ISIDRO, PALOMPON,
ROBERTO JOSEPH PAJARON M 04-26-1963 MARRIED LEYTE 09058244557
Note: Use additional page if necessary. BAT shall be composed of one member per 80 residents; 25 members per 2,000 residents.
INDICATOR UNIT OF CLUSTER FIRST NAME LAST NAME SEX BIRTH DATE CIVIL STATUS ADDRESS CONTACT #
BRGY. SAN ISIDRO, PALOMPON,
PROPER/ SITIO CACAO ANTONIO ADLAWAN M 04-20-1956 MARRIED LEYTE 09972586681
BRGY. SAN ISIDRO, PALOMPON,
SITIO BITA-UG ANTONIO SON M 5/7/1957 MARRIED LEYTE 09068207559
BRGY. SAN ISIDRO, PALOMPON,
SITIO TAYPO/BAKILID GILBERT PINTOY M 4/11/1975 MARRIED LEYTE 09269039891
BADAC House
BRGY. SAN ISIDRO, PALOMPON,
Clusters are SITIO PASIL CRESENCIO ONG M 11-28-1950 WIDOWER LEYTE 09068207810
organized
BRGY. ROAD/ SITIO BRGY. SAN ISIDRO, PALOMPON,
TORRIL ARTURO VIVERO M 07-11-1944 MARRIED LEYTE 09358568480
BRGY. SAN ISIDRO, PALOMPON,
SITIO SALVACION JOENARD MERCADO M 08-27-1981 MARRIED LEYTE 09306258237
SITIO SAN MARTIN/ BRGY. SAN ISIDRO, PALOMPON,
ISLA VERDE CONCEPCION MONTERO M 01-18-1956 MARRIED LEYTE 09265336990
Note: Use additional page if necessary. Examples of Unit of Cluster are by purok, by sitio, by block, by zone, by street, etc.
CONCURRENT
INDICATOR DESIGNATION FIRST NAME LAST NAME SEX BIRTH DATE CIVIL STATUS ADDRESS CONTACT #
(if applicable)
BRGY. SAN ISIDRO, PALOMPON,
Barangay Duty BADAC OFFICER BRIAN GORUMBA M 12-29-1980 MARRIED LEYTE 09950676124
Officers are
designated

Note: Use additional page if necessary. Concurrent Designation refers to the primary appointment / item of the designated Brgy Duty Officer in the barangay, e.g. Barangay
Health Worker, VAWC Desk Officer, etc.
 Page 3
BADAC DATA CAPTURE FORM 2
DURATION SPEAKER /
INDICATOR ACTIVITY TITLE VENUE LEAD ORGANIZER
DATE (MM/DD/YYYY) TIME FACILITATOR

Trainings Attended
by Punong
Barangay on
Strengthening
BADACs

Note: Use additional page if necessary.

DURATION SPEAKER /
INDICATOR ACTIVITY TITLE VENUE LEAD ORGANIZER
DATE (MM/DD/YYYY) TIME FACILITATOR

Trainings /
Planning Session
Attended by
Punong Barangay
on CSAR

Note: Use additional page if necessary.

NO. OF
DURATION SPEAKER /
INDICATOR ACTIVITY TITLE VENUE PARTICIPANTS
DATE (MM/DD/YYYY) TIME FACILITATOR MALE FEMALE

Trainings
Conducted by
BADAC for House
Cluster Leaders

Note: Use additional page if necessary.

NO. OF
DURATION SPEAKER /
INDICATOR ACTIVITY TITLE VENUE PARTICIPANTS
DATE (MM/DD/YYYY) TIME FACILITATOR MALE FEMALE

Trainings
Conducted by
BADAC for BADAC
Auxiliary Team

Note: Use additional page if necessary.

DURATION SPEAKER /
INDICATOR ACTIVITY TITLE VENUE LEAD ORGANIZER
DATE (MM/DD/YYYY) TIME FACILITATOR

Trainings Attended
by Barangay Duty
Officers
Note: Use additional page if necessary.
 Page 4
BADAC DATA CAPTURE FORM 3

DURATION NO. OF PARTICIPANTS

INDICATOR ACTIVITY TITLE VENUE PRESIDING OFFICER
DATE (MM/DD/YYYY) TIME MALE FEMALE

Conduct of
BADAC
Consultative
Meetings

Note: Use additional page if necessary.

DURATION NO. OF PARTICIPANTS
INDICATOR ACTIVITY TITLE VENUE PRESIDING OFFICER
DATE (MM/DD/YYYY) TIME MALE FEMALE

Conduct of
BADAC Monthly
Meetings

Note: Use additional page if necessary.

DURATION NO. OF PARTICIPANTS
INDICATOR ACTIVITY TITLE VENUE TARGET AUDIENCE
DATE (MM/DD/YYYY) TIME MALE FEMALE

Organization/Co-
organization of
Community-based
IEC Campaign
Activities

Note: Use additional page if necessary.

DURATION NO. OF PARTICIPANTS
INDICATOR ACTIVITY TITLE VENUE TARGET AUDIENCE
DATE (MM/DD/YYYY) TIME MALE FEMALE

Organization/Co-
organization of
School-based IEC
Campaign
Activities

Note: Use additional page if necessary.

 Page 5

BADAC DATA CAPTURE FORM 3

DURATION NO. OF PARTICIPANTS

INDICATOR ACTIVITY TITLE VENUE TARGET AUDIENCE
DATE (MM/DD/YYYY) TIME MALE FEMALE

Conduct of Youth-
led IEC Campaign
Activities

Note: Use additional page if necessary.

DURATION NO. OF PARTICIPANTS
INDICATOR ACTIVITY TITLE VENUE TARGET AUDIENCE
DATE (MM/DD/YYYY) TIME MALE FEMALE

Conduct of CSO-
led IEC Campaign
Activities

Note: Use additional page if necessary.

DURATION NO. OF PARTICIPANTS
INDICATOR ACTIVITY TITLE VENUE TARGET AUDIENCE
DATE (MM/DD/YYYY) TIME MALE FEMALE

Organization/Co-
organization of
Activities in
Observance of the
IDADAIT

Note: Use additional page if necessary.

DURATION NO. OF PARTICIPANTS
INDICATOR ACTIVITY TITLE VENUE TARGET AUDIENCE
DATE (MM/DD/YYYY) TIME MALE FEMALE

Organization/Co-
organization of
Activities in
Observance of the
DAPC Week

Note: Use additional page if necessary.

 Page 6
BADAC DATA CAPTURE FORM 4
UNIFIED BARANGAY REPORT ON REFERRAL ACTION (UBRRA)

Data provided herein are those recorded within the months of: January to June ( ) July to December ( ) Year (YYYY): __________________________

NO. OF SURRENDERERS NO. OF REFERRED SURRENDERERS

INDICATOR INDICATOR
MALE FEMALE MALE FEMALE
TOTAL TOTAL
BELOW 18 ABOVE 18 BELOW 18 ABOVE 18 BELOW 18 ABOVE 18 BELOW 18 ABOVE 18

Submission of Updated
Submission of Updated Number
Number of Residents who
of Referred Surrenderers
Surrenderred

NO. OF SURRENDERERS ENROLLED IN WELLNESS &

STATUS / STATUS AND NO. OF ASSESSED SURRENDERERS WELLNESS & RECOVERY INTERVENTIONS
INDICATOR LEVEL OF INDICATOR RECOVERY
RISK MALE FEMALE INTERVENTIONS MALE FEMALE
TOTAL TOTAL
BELOW 18 ABOVE 18 BELOW 18 ABOVE 18 BELOW 18 ABOVE 18 BELOW 18 ABOVE 18

General
Low
Interventions

Community-based
Mild Submission of Treatment &
Submission of Rehab
Updated
Updated Number
Number of
of Assessed Health Facility-
Enrolled
Surrenderers based Outpatient
Moderate Surrenderers
Treatment &
Rehab

Inpatient
Severe Treatment &
Rehab

NO. OF SURRENDERERS WHO COMPLETED WELLNESS &

RECOVERY INTERVENTIONS The purpose of this form is to determine the number of surrenderers per semester (January-
INDICATOR June, July-December), and monitor the number of who, among those surrenderers, have
MALE FEMALE been referred, assessed, and who have completed any Wellness and Recovery Program
TOTAL
BELOW 18 ABOVE 18 BELOW 18 ABOVE 18 interventions within the 6-month time frame. Counting shall restart at the onset of the new
Submission of Updated semester; meaning, the data on those who surrendered in the previous semester shall no
Number of Surrenderers Who longer be accounted in the next, regardless of whether they have been referred or assessed
Completed Wellness & in the following semester.
Recovery Interventions
Number of Surrenderers Who longer be accounted in the next, regardless of whether they have been referred or assessed
Completed Wellness & in the following semester.
Recovery Interventions
 Page 7
BADAC DATA CAPTURE FORM 5
COMMUNITY SUPPORT, AFTERCARE AND REINTEGRATION (CSAR)

Data provided herein are those recorded within the months of: January to June ( ) July to December ( ) Year (YYYY): __________________________

NO. OF CSAR ENROLLEES NO. OF CSAR GRADUATES

INDICATOR INDICATOR
MALE FEMALE MALE FEMALE
TOTAL TOTAL
BELOW 18 ABOVE 18 BELOW 18 ABOVE 18 BELOW 18 ABOVE 18 BELOW 18 ABOVE 18
Submission of
Submission of Updated Updated Number of
Number of Residents Residents Who
Enrolled in CSAR Program, Completed the
or its equivalent CSAR Program, or
its equivalent

The purpose of this form is to determine the number of residents enrolled in CSAR Program, or its equivalent, per semester (January-June, July-December), and monitor the number of
who, among those enrolled, have completed the CSAR program within the 6-month time frame. Counting shall restart at the onset of the new semester; meaning, the data on those
enrolled in the previous semester shall no longer be accounted in the next, regardless of whether they have been referred or assessed in the following semester.
 Page 8
BADAC DATA CAPTURE FORM 6
SUMMARY OF CONSOLIDATED INFORMATION REPORT
as per Section 8 of DDB Board Regulation No. 3, s. 2017
Year (YYYY): _________

Data provided herein are those recorded within the months of: January to March ( ) April to June ( ) July to September ( ) October to December ( )

DRUG SUPPLY DRUG TRANSIT / CLANDESTINE

DRUG PUSHER DRUG USER / DEPENDENT
INDICATOR AVAILABILITY TRANSHIPMENT ACTIVITY LABORATORY

PRESENT / ABSENT TOTAL PRESENT / ABSENT TOTAL PRESENT/ABSENT PRESENT/ABSENT PRESENT/ABSENT

Submission of
Updated Summary of CLANDESTINE CHEMICAL MARIJUANA CULTIVATION DRUG DEN, DIVE OR DRUG PROTECTOR /
CLANDESTINE DRUG WAREHOUSE
Consodated WAREHOUSE SITE / PLANTATION RESORT CODDLER & FINANCIER
Information Report
(CIR)

PRESENT/ABSENT PRESENT/ABSENT PRESENT/ABSENT PRESENT/ABSENT PRESENT/ABSENT