Republic of the Philippines

Department of Education
Region I
SCHOOLS DIVISION OFFICE I PANGASINAN

School-Based Report on Incidents of Child Abuse

School Year 2021-2022
School: TOBOR NATIONAL HIGH SCHOOL Classification (Public/Private): PUBLIC
Address: TOBOR, MALASIQUI, PANGASINAN Level (Kindergarten/Elementary/Secondary): SECONDARY

Date/Place Nature of Abuse Victims Perpetrator Relationship to Action Taken Status

of Incident the Victim (Resolved/Pending/Referred
Physica Social Gender- Cyber Retaliation LRN Age Sex Name Age Sex to other agency)
l Based Bullying (Optional/Alias)
(M/F) (M/F)

- 0 0 0 0 0 - - - - - - - - -

- - - - - - - - - - - - - - -

Total 0 0 0 0 0

Note: Child Abuse refers to the maltreatment of a child whether habitual or not, which includes any of the following:
● Physical – refers to acts that inflict bodily harm and which subject children to perform tasks that are hazardous to their physical well-being

● Sexual – refers to acts that are sexual in nature such as rape, sexual harassment, sexually demeaning remarks, forcing children to watch obscene publications or shows, etc.

● Psychological – refers to acts or omissions causing or likely to cause mental or emotional suffering to the child which includes intimidation, harassment, stalking, public ridicule, threat of deduction from grade or merit as form
of punishment, and repeated verbal abuse
Relationship to the victim (Perpetrator) refers to Relatives (father, mother, cousin, etc.) or School Personnel (teachers and non-teaching staff)
No amicable settlement for any acts of child abuse.
 Republic of the Philippines
Department of Education
Region I
SCHOOLS DIVISION OFFICE I PANGASINAN

This form shall be used by both Public and Private schools.

Prepared by: Reviewed and Confirmed by:

RUBY LYN G. GOMERA JANUS B. SALINAS

(School Child Protection Focal Person/Guidance Counselor) Principal II
Date: JULY 15, 2022 Date: JULY 15, 2022