VAC Form 1

BARANGAY DATA CAPTURE FORM

MONITORING OF INCIDENCE ON VIOLENCE AGAINST CHILDREN (VAC) DURING THE COVID-19 PANDEMIC
For the period: May 1-31, 2024

Region: III
Province: BULACAN
City/Municipality: PAOMBONG
Barangay: SAN ISIDRO II

GENDER TYPES OF VIOLENCE PERPETRATORS ACTIONS TAKEN BY THE BARANGAY/BCPC

(2) (4) (5) (6)
VAC Others
Immediate Other Referred for Referred for
VICTIM/ Male Femal AGE Physical Sexual Psychological Neglec
Family Close
Acquaint Strange Local Law (ex: Referred to Referred Referred
Medical Legal
Others
S e (3) Abuse Abuse /Emotional t ance r Official Enforcer Guardian LSWDO to PNP to NBI (ex: Referred to NGOs, FBOs)
(2a) Member Relative Treatment Assistance
(1) (2b) (4a) (4b) Abuse(4c) (4d) (5c) (5d) (5e) (5f) ) (6a) (6b) (6c) (6f)
(5a) (5b) (6d) (6e)
(5g)
pls.
✔=1 ✔=1 ✔=1 ✔=1 ✔=1 ✔=1 ✔=1 ✔=1 ✔=1 ✔=1 ✔=1 ✔=1 ✔=1 ✔=1 ✔=1 ✔=1 ✔=1 pls. specify
specify

None for this period.

TOTAL 0 0
*Immediate Family Member/s – parents and siblings
*Other Close Relative/s – uncles, aunts, grandparents, cousins, etc.
*If ✔, encode "1" on the applicable fields
*If "Others," please specify

Submitted by:
VAC Form 1
BARANGAY DATA CAPTURE FORM
MONITORING OF INCIDENCE ON VIOLENCE AGAINST CHILDREN (VAC) DURING THE COVID-19 PAND
For the period: MAY 16, 2020 - JUNE 15, 2020

Region:___ III
Province:______________________________________
City/Municipality:_______________________________
Barangay:____________________________________

GENDER TYPES OF VIOLENCE PERPETRATORS ACTIONS TAKEN

VAC (2) (4) Immediate (5)
AGE Physical Sexual Psychological/ Other Close Local Law Others Referred to Referred
VICTIM/S Male Female Neglect Family Acquaintance Stranger
(3) Abuse Abuse Emotional Abuse Relative Official Enforcer (ex: Guardian) LSWDO to PNP
(1) (2a) (2b) (4d) Member (5c) (5d)
✔=1 ✔=1 ✔(4a)
=1 (4b)
✔=1 (4c)
✔=1 ✔=1 ✔(5a)
=1 ✔(5b)
=1 ✔=1 ✔=1 ✔(5e)
=1 ✔(5f)
=1 pls. (5g)
specify ✔(6a)
=1 ✔(6b)
=1
Child 1

Child 2

Child 3

TOTAL
*If ✔, encode "1" on the applicable fields *Immediate Family Member/s – parents and siblings
*If "Others," please specify *Other Close Relative/s – uncles, aunts, grandparents, cousins, etc.

Submitted by: Name and Signature

Punong Barangay
D-19 PANDEMIC

ACTIONS TAKEN BY THE BARANGAY/BCPC

Referred
(6) for Referred for Others
Referred
Medical Legal (ex: Referred to
to NBI
Treatment Assistance NGOs, FBOs)
(6c)
✔=1 ✔(6d)
=1 ✔(6e)
=1 pls. (6f)
specify

Signature
Barangay