DepEd Form 1

NATIONAL SCHOOL DEWORMING MONTH SY _____________

Masterlist and Recording Form for Soil Transmitted Helminthiasis

Division/District: _ALBAY/___________________________ Date: __________________

School: __________________________________________
School Address: ___________________________________
Grade Level/Section: _______________________________
Birth Sex Dewormed 4P's Member IPs Member
Name of Pupils/Students
Age Date M F Address Y N Y N Y N Remarks
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40

LEGEND: Month of _______________

IPs - Indigenous People 10-19 y/o
M F Total
Enrolment
Dewormed
Accomplished by: % of Accomplishment
4Ps Enrolled
4Ps Dewormed
Class Adviser 4Ps % of Accomplishment
(Signature Over Printed Name) IPs Enrolled
IPs Dewormed
IPs % of Accomplishment
 Remarks

____
DepEd Form 2 (Sec)

NATIONAL SCHOOL DEWORMING MONTH

SY _2022-2023________ Month of AUGUST-DECEMBER 2022___________

Province: _ALBAY______________________________________
District: ______________________________________________
School: _____________________________________________
Address: _____________________________________________
Date: ______________________________________________

10-19 years old

*Enrolment **Dewormed % of Accomplishment 4Ps Enrolled 4Ps Dewormed 4Ps % of Accomplishm

Grade
M F Total M F Total M F Total M F Total M F Total M F
Grade 7
Grade 8
Grade 9
Grade I0
Grade 11
Grade 12
Grand Total
*Enrolment = All Enrolment (4Ps + non 4Ps + IPs + not IPs)
**Dewormed = All pupils/students dewormed (4Ps + non 4Ps + IPs + not IPs)

Accomplished by:

Principal/School Head
(Signature Over Printed Name)
______

IPs (Indigenous People)

omplishment IPs Dewormed IPs % of Accomplishment
Enrolled
Total M F Total M F Total M F Total