Republic of the Philippines

Department of Education
Region IV – A CALABARZON
SAN MIGUEL ELEMENTARYSCHOOL
Pila Sub - Office

INCIDENT REPORT FORM

TYPE OF INCIDENT

EARTHQUAKE 6.3
INCLUSIVE DATE AND TIME OF INCIDENT

JUNE 15, 2023 – 10:19 AM

EXACT LOCATION OF INCIDENT:

Pila Senior High School – Barangay Pinagbayanan, Pila, Laguna

INVOLVED PERSONS & SPECIFIC PARTICIPATION:

PRIMITIVA D. OCAMPO – SCHOOL HEAD

NORIEL D. DEL ROSARIO– SDRRM COORDINATOR
ALLAN TRILLANES – SCHOOL JO
PILA SENIOR HIGH SCHOOL TEACHING AND NON – TEACHING PERSONNEL

NARRATIVE DETAILS OF INCIDENT: (Describe how the incident happened, scene of incident, physical and
emotional state of involved persons, description of injuries/damages to properties, impact to class/school/community, etc. Use
back page if needed.)

At around 10:19 in the morning of June 15, 2023, an earthquake w occurs during school hours.

An unusual crack in classroom, laboratories and other facilities were visibly noticed during teachers’
initial inspection of classrooms and buildings

ACTION/S TAKEN: (Narrate responses/decisions implemented by school authorities, state name of official. Use back
page if needed.)

After the earthquake the Teaching and Non-Teaching personnel’s ensure the safety of learners. The SDRRM group conduct initial
inspections to the school facilities for the safety of the learners.
RECOMMENDATIONS: (State suggestions that higher DepEd officials/other government agencies must perform further
to fully respond to situation. Use back page if needed.)

A thorough inspection from the authorities concerned should be done.

REPORTED BY: (Full name, position/designation and signature) DATE RECEIVED: (to be accomplished
by SGOD staff)

NORIEL D. DEL ROSARIO

REVIEWED BY: (Full name, position/designation and signature) RECEIVED BY: (to be accomplished by
SGOD staff)
 PRIMITIVA D. OCAMPO
School Head
NOTED BY: (Full name, position/designation and signature)

FLORENTINA C. RANCAP, EdD

Public School District Supervisor

Attached to this report are the pictures in the incident