School-Based Report On Incidents of Bullying SY 2020-2021

SCHOOL-BASED REPORT ON INCIDENTS OF BULLYING
SY 2020-2021
School: __________________________________ Classification: (Private/Public) ______________________

Address: __________________________________ Grade Level: _____________________________________
Date/ Place Name of Bullying Victims Status

of Incident Action Recommendation (Resolved/
Taken Pending/
Referred to
other Agency)
Physical Social Gender- Cyber Retaliation Name Age Sex
Based Bullying (F/M)
Note: Bullying is perpetrated by a student against another student which may be:
 Physical- unwanted physical contact (punching, shoving, pushing, kicking, slapping, tickling, headlocks etc.)
 Social- refers to any deliberate, repetitive, aggressive social behaviour intended to hurt or belittle an individual (name-calling, cursing, labelling, etc.)
 Gender-based- refers to any act that humiliates or excludes a person on the basis of perceived or actual sexual orientation and gender identity
 Cyber Bullying- any bullying done through the use of technology or any electronic means (texting, email, chatting, online games etc.)
Reviewed and Conformed by: __________________ Prepared by: __________________

Name and Designation Name and Designation
Date: __________________ Date: __________________
SCHOOL-BASED REPORT ON INCIDENTS OF CHILD ABUSE

SY 2020-2021
School: __________________________________ Classification: (Private/Public) ______________________
Address: __________________________________ Grade Level: _____________________________________
Nature of Abuse Victims Perpetrators Relationship to Action Status
the Victim Taken (Resolved/
Pending/
Referred to
Date of other Agency)
Incident Physical Sexual Verbal/ NAME Age Sex NAME Age Sex
Psychologica (Last Name, First (M/F) (Last Name, First (M/F)
l Name, M.I.) Name, M.I.)
TOTAL
Note: Child abuse refers to the maltreatment of a child, whether habitual or not, which includes any of the following:
 Physical- refers to acts that inflict bodily harm and which subject s children to perform tasks which are hazardous to their physical well-being;
 Sexual- refers to acts that are sexual in nature such as rape, sexual harassment, sexually demeaning remarks. forcing children to watch obscene publications or shows
etc.; and
 Psychological- refers to acts or omissions causing or likely to cause mental or emotional suffering to the child which include intimidation, harassment, stalking, public
ridicule, threat of deduction from grade or merit as a form of punishment, and repeated verbal abuse.
Relationship to the victim refers to relatives (father, mother, cousin etc.) or school personnel (teachers and non-teaching staff)
No amicable settlement for any acts of child abuse
Reviewed and Conformed by: __________________ Prepared by: __________________

Name and Designation Name and Designation
Date: __________________ Date: __________________
School: _______________________
Period Covered: ________________
A. Consolidated Report on Incidents of Children in Conflict with the Law (CICL)

Learner’s Reference Age Case/Violation Action Taken Intervention/ Diversion Program Remarks
Number Sex
(LRN) (M/F)
B. Description of any intervention program or diversion program that the school initiated or adopted which facilitated the reintegration of the CICL in the school and
community
Prepared by: Noted by:
____________________ ____________________
Designation School Head
CONSOLIDATED REPORT ON CASES OF CHILDREN – AT – RISK (CAR)
School: _______________________
Period Covered: ________________
I. CHILDREN- AT –RISK (CAR)

Classification No. of Students Action Taken Remarks
1. Victim of abuse 9sexual, physical, Male Female
psychological, mental, economic, and
other mean
2. Victim of Neglect
3. Coming from a dysfunctional family or
without parent or guardian
4. Being member of a gang
5. Living in a community with a higher
level of criminality
6. Living in a situation of armed conflict
7. Committed a status of offense under
section 57 of RA 9344, as amended
8. Prostituted Children
9. Mendicant under PD 1563
10. Solvent/ Rugby User
11. Others
II. Description of action taken by the school to alleviate the risk factors of the CAR:
Prepared by: Noted by:
____________________ ____________________
Designation School Head

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SCHOOL-BASED REPORT ON INCIDENTS OF BULLYING

School: ____________ Classification: (Private/Public)

Date/ Place Name of Bullying Victims Status

Reviewed and Conformed by: Prepared by:

SCHOOL-BASED REPORT ON INCIDENTS OF CHILD ABUSE

Reviewed and Conformed by: Prepared by:

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

Prepared by: Noted by:

I. CHILDREN- AT –RISK (CAR)

Prepared by: Noted by:

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