(Enclosure No. 1A to DepEd Memorandum No. 59, s.

2015)

SCHOOL-BASED REPORT ON INCIDENTS OF BULLYING

School Year 2017-2018
For the Month of July to August 2017 (3rd Quarter)

School: SAN RAFAEL ELEMENTARY SCHOOL (SRES) Classification (Public / Private): PUBLIC
Address: SAN RAFAEL ST., BRGY. SAN RAFAEL, SAN FELIPE, ZAMBALES Level (Kindergarten / Elementary / Secondary):

Nature of Bullying VICTIMS PERPETRATOR SCHOOL

Date / Place of the
Gender- Cyber- Sex Sex
Incident Physical Social Retaliation Name Age Name Age Action Taken
Based Bullying (M/F) (M/F)
n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a

***NOTHING FOLLOWS***

NOTE: Bullying is perpetrated by a student against another student which may be:
 Physical - unwanted physical contact (punching, shoving, pushing, kicking, slapping, tickling, headlocks, etc.)
Social - refers to any deliberate, repetitive and aggressive social behavior intended to hurt or belittle an individual (name-calling, cursing, labelling, etc.)
Gender-Based - refers to any act that humiliates or excludes a person on the basis or perceived or actual sexual orientation and gender identity
Cyber Bullying - any bullying done through the use of technology or any electronic means (texting, email, chatting, online games, etc.)

Prepared by: Reviewed and Conformed by:

SHEILA M. ESPOSO ISAGANI C. CANONIZADO

Teacher III School Principal III
Date: September 15, 2017 Date: September 15, 2017
-BASED REPORT ON INCIDENTS OF BULLYING
School Year 2017-2018
he Month of July to August 2017 (3rd Quarter)

PUBLIC
KINDERGARTEN & ELEMENTARY

SCHOOL
Status
Recommendation
(Resolved/Pending/Referred to other agency)
n/a n/a

***NOTHING FOLLOWS***
ISAGANI C. CANONIZADO
School Principal III
Date: September 15, 2017
(Enclosure No. 1B to DepEd Memorandum No. 59, s. 2015)

SCHOOL-BASED REPORT ON INCIDENTS OF CHILD ABUSE

School Year 2017-2018
For the Month of July to September 2017 (3rd Quarter)

School: SAN RAFAEL ELEMENTARY SCHOOL Classification (Public / Private): PUBLIC

Address: SAN RAFAEL ST., BRGY. SAN RAFAEL, SAN FELIPE, ZAMBALES Level (Kindergarten / Elementary / Secondary): KINDERGARTEN & ELEMENTARY

Nature of Abuse VICTIMS PERPETRATOR SCHOOL

Date / Place of
Verbal / Name Sex Name SexRelationship to
the Incident Physical Sexual Age Age Action Taken
Psychological (Last Name, First Name, MI) (M/F) (Last Name, First Name, MI) (M/F) the Victim
n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a

Note:
Child Abuse refers to the maltreatment of a child, whether habitual or not, which includes any of the following:
Physical - refers to acts that inflict bodily harm and which subjects children to perform tasks which are hazardous to their physical well-being;
Sexual - 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

Prepared by: Reviewed and Conformed by:

SHEILA M. ESPOSO ISAGANI C. CANONIZADO, Ed. D.

Teacher III School Principal III
Date: September 15, 2017 Date: September 15, 2017
 SED REPORT ON INCIDENTS OF CHILD ABUSE
School Year 2017-2018
Month of July to September 2017 (3rd Quarter)

PUBLIC
KINDERGARTEN & ELEMENTARY

SCHOOL
Status
(Resolved/Pending/Referred to other agency)
n/a

ual harassment, sexually demeaning remarks, forcing children to watch obscene publications or shows etc.; and
se mental or emotional suffering to the child which include intimidation, harassment, stalking, public ridicule, threat of