deworming sses

7/25/2019 Deworming SSES

1/20

National School Deworming Day June 27,2016

ANNEX C: Form 1 MODIFIED deworming checklist

Province Laguna

Division Santa Rosa ity

District 1stName o! School Santa Rosa "lementary School entral ### $S%ecial Science "lementary

School '((ress

)otal "nrolment

*ra(e +# SS"S

Number Enrolled Name o Child with consent dewormed !

()*s

1 '-a(, 'ngelo P. 1

2 /aa(era, ico "mison . 1

/eato, 3ienweiss . 1

4 a%istrano, Jhon Lester ). 1

5 De *uman, Jare( *rant L.

6 Dichoso, "eiel '.7 8a9utagana, Rain Paul . 1

: Latum-o, Jenenric .

; analansan, 'aron iguel . 1

10 anguerra, arius .

11 u9eco, Re( . 1

12 Rica!ort, *o(win iles *. 1

1 Rol(an, /ran(on James L.

14 )rianes, Johann arlo '.

15'nas, 'n(rielle D.

116 /arroga, hienna Reian S.

17 /eato, Jeian S. 1

1: /ri, Princess )risha Joy .

1; astro(es, Phoemela Denise /. 1

20 lacio, Rocelle +. 1

21 Dela ru, arie /eatrice N. 1

22 Diestro, a. =ristine . 1

2 Jurilla, Neah +enice /. 1

24 Llamas, 'ngel assan(ra 1

25 Lum-ris, ?ane *a-rielle /. 1

26 on(iguing, Syllen 'nn '.

*ra(e Level an(Section


2/20

27Nuarin, *hislaine S.

2: >larte, Penelo%e P.

2; Palacios, iaela '. 1 1

0 Pere, #shiah Jarah S.

1Rol(an, Dylene Jane L.

2 Servo, 'thena . 1

Solomon, Lea 'ngela D. 1

4 )umanan, Nicole =ate .

5 )umil-a, *race @o%e R.

MERNIE GRACE F. DIONESIO

Date 'ccom%lishe( 22Jun16

2

lass '(viser$Name an(Signature&


3/20

chool&

+emarks or not being dewormed

une 1#"ul$ %&'

non#()*s

1 1

1 1

1 1

1 1

1 1 1

1 11 1

1 1

1 1

1 1 1

1

1 1

1 1 1

1 1

1

1 1 1

1 1

1 1 1

1 1

1 1

1 1

1 1

1 1

1

1 11 1 1

Ineligible

!dewormedbeore "une

1'

+euseddeworming

deerred

due to,re-alence

sur-e$

)recautionar$ Measure!seriousl$ ill. with

abdominal ,ain. diarrhea.who has ,re-ioush$,ersensiti-it$ with

deworming drug ! anne/ 0MDA) uide 21 ,age 1('


4/20

1 1

1 1 1

1

1 1

1 11

1

1 1 1

1 1 1

"RN#" *R'" 8. D#>N"S#>

*ra(e Level'(visor $Namean( Signature&


5/20

National School Deworming Day July 2;, 2015

ANNEX C: Form 1 MODIFIED deworming checklist

Province Laguna

Division Santa Rosa ity

District 1stName o! School Santa Rosa "lementary School entral ### $S%ecial Science "lementary

School '((ress

)otal "nrolment

*ra(e 1 amia

Number Enrolled Name o Child with consent dewormed !

()*s

1 'lgoso, lar John *.

2 'lo9a(o, Ronielle Jose%h +.

'mihan, Jhai(en Josh orana

4 agaanan, Prince Jeral( D.*

5 Cay, Jerry Jr. B.

6 De Leon, Zan Kelly Yanzhie Jr. B. 17 Diaz, Ashlei Gean N.

: Dimayuga, Kenneth B. 1

; Endozo, Lynderson s!hyron D.

10 8ernan(e, Jhon.

11 Grim"luna, #att Gerald E. 1

12 Gusi, $o%in &illiam C.

1 Gue'arra, $o(ell Jr. C.

14 Layosa, Jason D. 1

15Ling!od, #i!)enzie Joshua J

1

16 Lo'enden!io, John Carlo #.

17 #anla"it, Josh *erez

1: #arudo, Nathan B.

1; #edrano, Ga%riel +illa

20 #ondear, John Da'id L.

21 Ne!esito, $e- Justine A.

22 rana, Arnold C.

2 ti'ar, #ar /te'en C.

24 *anling%atan, Bien Jairus B. 1

25 /aul, $heian Claud *.

26 0alion, John +in!ent N.

*ra(e Level an(Section


6/20

27An, Angeli!a #ay 1. 1 1

2:Aunario, #i!helle Jaeda D.+

2; Bartolazo, Jamai!a Keith N.

0 Burinaga, Jasmen G. 1

1 De la Cruz, #aranah D. 12 Em%odo, Katrina #ae D 1

2uentes, Ceana Casey $. 1

4 Geroy, lin $iona .

5 Gomez, #a. Ysa%elle 0.

6 gonia, $hian C.

7 no3re, /hane Ann L.

: Jimenea, 0hrishia L. 1

; $amos, Audrey *.

40 /alandanan, Kriselle C.

(3 3 1% 1

'ccom%lishe( -yA

LB"N' . +'L"

Date 'ccom%lishe( 1Jul15

2

lass '(viser$Name an(Signature&


7/20

chool&


une 1#"ul$ %&'

non#()*s

1 1

1 1

1 1

1 1

1 1

11 1

1

1 1

1 1

1

1 1

1 1

1

1

1 1

1 1

1 1

1 1

1 1

1 1

1 1

1 1

1

1 11 1

Ineligible

!dewormedbeore "une

1'

+euseddeworming

deerred

due to,re-alence

sur-e$


abdominal ,ain. diarrhea.who has ,re-ioush$,ersensiti-it$ with



8/20

1

1 1

1 1

1

11

1

1 1

1 1

1 1

1 1

1

1 1

1 1

1% %4 %4 3 3

Note( -y

LB"N' . +'L"*ra(e Level'(visor $Namean( Signature&


9/20


ANNEX C: Form % MODIFIED 5chool 6e-el +e,orting Form

Province

Division

DistrictName o! School e.g.Pinag-uhatan "lementary School

School '((ress

)otal "nrolment

rade 6e-el No7 o Enrolled Children with consent

children

( )*s

=in(er 12 12

*ra(e 1

*ra(e 2

*ra(e

*ra(e 4

*ra(e 5

*ra(e 6

8O8A6 1% 1%

'ccom%lishe( -yA

Date 'ccom%lishe(

School Princi%al$Name an(Signature&


10/20

2


11/20


ewormed

non ( )*s

12 2: 2: 0 0

1% %4 %4 3 3

Note( -y

Ineligible!dewormedbeore "une

1'

+euseddeworming

deerreddue to

,re-alence

sur-e$


abdominal ,ain. diarrhea.who has ,re-ious

h$,ersensiti-it$ with


DistrictSu%ervisor $Namean( Signature&


12/20


13/20


ANNEX C: Form 9 MODIFIED DII5ION 6e-el +e,orting Form

+egion

)ro-ince

Di-ision

Name o 5chool No7 o Enrolled Children with consent

children

( )*s

12 12

8O8A6 1% 1% 3

'ccom%lishe( -yA

Date 'ccom%lishe(

Division PointPerson $Name an(Signature&


14/20

2


15/20


ewormed

non ( )*s

12 2: 2: 0 0

1% %4 %4 3 3

Note( -y


1'

+euseddeworming

deerreddue to

,re-alencesur-e$



h$,ersensiti-it$ withdeworming drug ! anne/ 0MDA) uide 21 ,age 1('

Schools DivisionSu%erinten(ent$Name an(Signature&


16/20


17/20


ANNEX C: Form (b MODIFIED +Egional 6e-el +e,orting Form

+egion

)ro-ince

Di-ision

Di-ision No7 o Enrolled Children with consent

children

( )*s

Rial 12 12

8O8A6 1% 1%

'ccom%lishe( -yA

Date 'ccom%lishe(

Division PointPerson $Name an(

Signature&


18/20

2


19/20


ewormed

non (*)s

12 2: 2: 0 0

1% %4 %4 3 3

Note( -y


1'

+euseddeworming

deerreddue to

,re-alencesur-e$



h$,ersensiti-it$ withdeworming drug ! anne/ 0MDA) uide 21 ,age 1('

Schools DivisionSu%erinten(ent

$Name an(Signature&

Date'ccom%lishe(


20/20

deworming sses

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