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Division Consolidated Reports On Incidents of Bullying and Retaliation
Division Consolidated Reports On Incidents of Bullying and Retaliation
Department of Education
Region IV B MIMAROPA
____________________________________________
____________________________________________
Division Consolidated Reports on Incidents of Bullying and Retaliation
School Year ____________
DISTRICT: _________________________
Division: _________________________
Total Number of Public Schools:
Elementary:
Secondary:
TOTAL: _______
NO.
NAME OF SCHOOL
SCHOOL
I.D.
PHYSICAL
NO. OF
MALE
VICTIMS
NO. OF
FEMALE
VICTIMS
NATURE OF BULLYING
PSYCHOLOGICAL
CYBER BULLYING
NO. OF
MALE
VICTIMS
NO. OF
FEMALE
VICTIMS
NO. OF
MALE
VICTIMS
NO. OF
FEMALE
VICTIMS
NO. OF
FEMALE
VICTIMS
TOTAL
NO. OF
MALE
VICTIMS
TOTAL
NO. OF
FEMALE
VICTIMS
GRAND
TOTAL
Submitted by:
____________________________________________
____________________________________________
Division Consolidated Reports on Incidents of Bullying and Retaliation
School Year ____________
DISTRICT: _________________________
Division: _________________________
Total Number of Public Schools:
Elementary:
Secondary:
TOTAL: _______
Policy Submitted *
NO.
NAME OF SCHOOL
SCHOOL I.D.
Submitted by:
____________________________________________
____________________________________________
Division Consolidated Reports on Incidents of Bullying and Retaliation
School Year ______________________
DISTRICT: _________________________
School I.D.: _________________________
School: _________________________
Address: _________________________
Classification (Public / Private) : _________________________
Level (kindergarten / Elementary / Secondary) : _________________________
Date of
Incident
(mm / dd /
yy)
NATURE
Physical
Psychologi
cal
Cyber
Bullying
VICTIMS
Retaliation
RESPONDENTS
Age Sex (M / F)
Action Taken
Age Sex (M / F)
Submitted by: