CP Form 1: Hazard Analysis

PROBABILITY IMPACT
HAZARD
RATE* REMARKS RATE**
Dengue 5 5
Typhoon 4 4
Earthquake 4 4
Fire 3 3
Landslide 2 2
Human Induced 2 2
Flood 2 2
Bomb Threat 1 1

*for the sample rating scale on probability and impact, refer to Contingency Planning Guidebook pp
**for the rating on impact, determine the rate in three (3) areas such as impact on life, property and
divide it by 3 (areas) to get the final rate.
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ard Analysis

AVERAGE
IMPACT PROBABILITY +
RANK
IMPACT
REMARKS
5 1
4 2
4 2
3 3
2 4
2 4
2 4
1 5

Planning Guidebook pp. 29

ct on life, property and public service continuity; add all the ratings and
 CP Form 2: Anatomy of the Hazard

HAZARD TO PLAN FOR Dengue

ROOT CAUSES EARLY WARNING SIGNS

Nausea and/or vomiting,headache,

Mosquito carrying dengue virus
rashes, fever and body pains

* for the detailed instructions in formulating this template, refer to Contingency Planning Guidebook pp. 32
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m 2: Anatomy of the Hazard

Dengue

EXISTING MITIGATING
TRIGGERING FACTORS
MEASURES

Cleaning the areas of the school,

clearing gutter and drainage
Flood, heavy rain, stagnant water, canal/open canal, removing
unsanitary environment, congested stagnant water, making sure that
area, plants that attract mosquitoes. water storage are properly closed,
screens, mosquito repellant instead
of fogging (liquid).

Contingency Planning Guidebook pp. 32

 CP Form 3A: Scenario Generation for Natural Hazard

PARTICULARS
BAD
(CAN BE CUSTOMIZED)

General Description of Event Limited number of cases

No. of Affected Learners (Male, Female, IP, Muslim, PWD) 1%

No. of Dead Learners (Male, Female, IP, Muslim, PWD) 0

No. of Injured Learners (Male, Female, IP, Muslim, PWD) 0

No. of Missing Learners (Male, Female, IP, Muslim, PWD) 0

No. of Affected Teaching Personnel (Male, Female) 0

No. of Dead Teaching Personnel (Male, Female) 0

No. of Injured Teaching Personnel (Male, Female) 0

No. of Missing Teaching Personnel (Male, Female) 0

No. of Affected Non-Teaching Personnel (Male, Female) 1

No. of Dead Non-Teaching Personnel (Male, Female) 0

No. of Injured Non-Teaching Personnel (Male, Female) 0

No. of Missing Non-Teaching Personnel (Male, Female) 0

EFFECTS
Infrastructure
-       Totally damaged CLs 0
-       Partially damaged CLs 0
-       Damaged WASH facilities 0
-       Damaged other infrastructures and ancillary facilities
0
(e.g., laboratories, clinic, library)
Non-infrastructure
-       Damaged furnitures and fixtures 0
-       Damaged learning resources and self-learning
0
modules
-       Damaged Information and Communication Technology
0
(ICT) equipment
-       Damaged laboratory equipment 0
-       Damaged medical and dental equipment and supplies 0
-       damaged technical-vocational supplies and equipment 0
Communication NA
Power/ Electricity NA
Transportation NA

PFA Trained,
Response Capabilities
BLS Trained

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Natural Hazard

WORSE WORST

Alarming rise of
cases in the Dengue outbreak
school/community
2% 3%

0 1

0 0

0 0

0 4

0 4

0 0

0 0

2 3

1 2

0 0

0 0

0 0
0 0
0 0

0 0

0 0
0 0

0 0

0 0
0 0
0 0
 NA NA
NA NA
NA NA

PFA Trained, PFA Trained,

BLS BLS
Trained Trained
 CP Form 3B: Scenario Generation for Human-Induced Hazard

PARTICULARS
BAD
(CAN BE CUSTOMIZED)

Limited number of
General Description of Event
cases

No. of Affected Learners (Male, Female, IP, Muslim, PWD) 8

No. of Dead Learners (Male, Female, IP, Muslim, PWD) 0
No. of Injured Learners (Male, Female, IP, Muslim, PWD) 0
No. of Missing Learners (Male, Female, IP, Muslim, PWD) 0
No. of Affected Teaching Personnel (Male, Female) 0
No. of Dead Teaching Personnel (Male, Female) 0
No. of Injured Teaching Personnel (Male, Female) 0
No. of Missing Teaching Personnel (Male, Female) 0
No. of Affected Non-Teaching Personnel (Male, Female) 0
No. of Dead Non-Teaching Personnel (Male, Female) 0
No. of Injured Non-Teaching Personnel (Male, Female) 0
No. of Missing Non-Teaching Personnel (Male, Female) 0
EFFECTS
Infrastructure
-       Totally damaged CLs 0
-       Partially damaged CLs 0
-       Damaged WASH facilities 0
-       Damaged other infrastructures and ancillary facilities
0
(e.g., laboratories, clinic, library)
Non-infrastructure
-       Damaged furnitures and fixtures 0

-       Damaged learning resources and self-learning modules 0

-       Damaged Information and Communication Technology

0
(ICT) equipment
-       Damaged laboratory equipment 0
-       Damaged medical and dental equipment and supplies 0
-       damaged technical-vocational supplies and equipment 0

Communication NA
Power/ Electricity NA
Transportation NA

PFA Trained,
Response Capabilities
BLS Trained

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n-Induced Hazard

WORSE WORST

Alarming rise of
cases in the Dengue outbreak
school/community
16 24
0 1
0 0
0 0
0 4%
0 4
0 0
0 0
1 25%
0 0
0 0
0 0

0 0
0 0
0 0

0 0

0 0

0 0

0 0

0 0
0 0
0 0

NA NA
NA NA
NA NA

PFA Trained, PFA Trained,

BLS Trained BLS Trained

 CP Form 4A.1: A

Displaced Learners
NO. OF
AREA/
LEARNERS Displaced Learners Inside Evacuation Centers
LOCATION
AFFECTED
k 1 2 3 4 5 6 7 8 9 10 11 12 PWD
PEMS 760 5 2 2 2 3 3 7 0 0 0 0 0 0 0

TOTAL

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 CP Form 4A.1: Affected Learners 

Displaced Learners

on Centers Total Displaced Learners Outside Evacuation Centers

Muslim ALS k 1 2 3 4 5 6 7 8 9 10 11 12 PWD Muslim ALS

0 0
 Reasons for
Total
Displacement
CP Form 4A.2: Affected Personnel

DISPLACED TEACHING PERSONNEL

NO. OF
TEACHING NO. OF TEACHING
AREA/ NO. OF TEACHING
PERSONNE PERSONNEL INSIDE PERSONNEL
LOCATION OUTSIDE
REASONS FOR
L EVACUATION DISPLACEMENT
AFFECTED EVACUATION
CENTERS
CENTERS
PEMS 0 0 0 0

TOTAL

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 DISPLACED NON-TEACHING PERSONNEL
NO. OF NON-
TEACHING NO. OF NON-TEACHING
NO. OF NON-TEACHING
PERSONNEL PERSONNEL INSIDE
OUTSIDE EVACUATION
REASONS FOR
AFFECTED EVACUATION DISPLACEMENT
CENTERS
CENTERS

0 0 0 0
 CP Form 4B.1: Breakdown of Affect

NO. OF BRE
AREA/ LEARNERS (FILL-UP ONLY
LOCATION AFFECTED K 1 2 3 4 5 6
M F M F M F M F M F M F M F M F
PEMS 15 9 2 3 1 1 1 1 1 1 3 0 2 1 5 2

TOTAL 15 9

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reakdown of Affected Learners

BREAKDOWN
(FILL-UP ONLY WHEN APPROPRIATE)
7 8 9 10 11 12 PWD Muslim ALS Others
M F M F M F M F M F M F M F M F M F
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
 CP Form 4B.2: Breakdown of Affected Personnel

NO. OF TEACHING PERSONNEL NO. OF NON-TEACHING PERSONNEL

AREA/ LOCATION AFFECTED AFFECTED

M F M
MET 0 0 0

TOTAL

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ted Personnel

ON-TEACHING PERSONNEL
AFFECTED OTHERS
F
0 0
 CP Form 5: Response Activities

TIMEFRAME
RESPONSE ACTIVITIES
(after the trigger)

Coordinate to BHW and/or City

Within 24 hours
Health
Cleaning of area in school and
Within 48 to 72 hours
community

After 72 hours and onwards Fogging (if needed)

Note: Refer to DepEd Order No. 33 s. 2021, Enclosure 2.

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Activities

RESPONSIBLE
TEAM/COMMITTEE

School Nurse

School Liason

School Nurse/School
Head/utility / LGU City health
office
 CP Form 6: Resource Inventory

TEAM/COMMITTEE RESOURCE QUANTITY REMARKS

Health Team School Nurse 1

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 CP Form 7: Resource Projection

GAPS
ACTIVITIES/
RESOURCE NEED HAVE SOURCES TO FILL
(NEED –
THE GAPS
HAVE)
Thermometer 24 24 0 None

TOTAL

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ojection

COST ESTIMATES
SOURCE OF FUNDS
(FILL-UP
(FILL-UP ONLY WHEN
ONLY WHEN
APPROPRIATE)
APPROPRIATE)
0 0
 CP Form 8: Emergency Operations Center

LOCATION met
CONTACT INFORMATION
Primary Alternate
Landline: Satellite Phone:

Mobile: Radio Frequency:

Email Address: Others:

Social Media:

Others:
EOC MANAGEMENT TEAM
NAMES AND AGENCY/ OFFICE/ CONTACT
POSITION
ORGANIZATION INFORMATION
(CUSTOMIZE AS APPROPRIATE) (PRIMARY AND ALTERNATE) (PRIMARY AND ALTERNATE)

EOC Manager

Operations Coordinator

Planning Coordinator

Logistics Coordinator

Finance/ Admin Coordinator

Others___________

Others___________

Others___________