Professional Documents
Culture Documents
TEMPLATE SchoolSafetyPlan
TEMPLATE SchoolSafetyPlan
Department of Education
REGION IV-A - CALABARZON
SCHOOLS DIVISION OF RIZAL
<School Name>
I. Introduction
A. Baseline Data
1) Number of Learners
Categories Grade Level Male Female
Kinder
1
Number of Learners 2
(excluding Muslims, 3
IPs, learners with 4
disability) 5
6
7
Number of Muslim Kinder
Learners 1
2
3
4
5
6
7
Kinder
1
2
Number of IP 3
Learners 4
5
6
7
Kinder
1
2
Number of Learners 3
with Disability 4
5
6
7
TOTAL
III. Situation
Action Taken / Current
No. Identified Incident Brief Summary
Control and Intervention
1
2
3
4
5
Address: <School Address>
School ID:
<School logo>
Contact Number:
Email Address:
Page 3 of 6
<Incident No.>
<Name>
<Contact Number>
<Position/Designation>
Lead
<Name>
<Contact Number>
<Position/Designation>
Alternate
<Name> <Name>
<Contact Number> <Contact Number>
<Position/Designation> <Position/Designation>
Internal Member External Member
A. Communication Directory
No. Internal/External Role Player Contact Details Office/Address
<Name> <mobile number>
(Internal/External) <e-mail address>
1
2
3
4
5
6
7
8
B. Communication Protocol
<Incident No.>
Intermediate Outcome 1
Intermediate Outcomes
Intermediate Outcome 2
Enabling Mechanisms
Sector Outcome
Goal
Intermediate Outcome 3
IX. Appendix
B. Memorandum of Agreement
Prepared by:
<NAME>
School Safety Plan Committee
<NAME> <NAME>
School Head Public School District Supervisor
Conformed:
<NAME>
<Internal and External Partner and Role Player>