Annex B.

Form 1 – Classroom Level

NATIONAL SCHOOL DEWORMING DAY

LEYTE
VIII (Eastern Visayas) Division: ________________________
Region: ______________ AREA 5-B
District: ________________________________
School ID: ______________________
303377 INOPACAN NATIONAL HIGH SCHOOL
Name of School: ___________________________________________________
38
Enrolment: _____________________ G9-AQUAMARINE
Grade level & Section: _______________________________________________

Enrolment Dewormed Remarks

NAME OF CHILD Actions
No.

Hand- Feeding Tooth- Taken

4P’s Non- 4P’s Non- washing brushing
4P’s 4P’s
1 Basinillo, Cedrick P.
2 Buhe, Nixon Y.
3 Cabigas, John
Joseph M
4 Cajes, Yandro C.
5 Dante, Ricardo Jr.
D.
6 Dedace, Edward
Rofe B.
7 Dumagsa, Alrod P.
8 Dumaguit, Randy S.
9 Estaura, James S.
1 Etang, Nick
0
1 Galo, Angelo B.
1
1 Larumbe, Gladymer
2
1 Logtas, Elmer P.
3
1 Matas, Marjone B.
4
1 Merano, Florince C.
5
1 Navalatan, Peter
6 Damiane
1 Nopal, Aaron L.
7
1 Sarzona, Jaypee D.
8
1 Suarez, Jeremias M.
9
2 Tan, Christian
0
2 Undras, Anjo B.
1
2 Aporador, Clarrise
2 Ma.
2
3 Baloja, Christy B.
 2
4 Beltran, Jeneffer R.
2
5 Cajes Ella Niña C.
2 Camanso, Clarissa
6 M.
2
7 Casil Christine D.
2
8 Dedal, Rocielle
2
9 Diaz, Chriszamae B.
3
0 Llano, Angel M.
3
1 Nopal, Raby Mae M.
3 Ocba, Mikaela Jade
2 N.
3
3 Oliveros, Avegyl E.
3
4 Omapas, Glenda
3
5 Sarong, Rowela M.
3 Suarez, Zayra mae
6 M.
3 Suicano, Nerie Chris
7 C.
3
8 Timon, Rubeilyn
39
40

Accomplished by: Noted by:

_____________________________________ _______________________________________
Class Adviser Clinic Teacher
Date Accomplished: ____________________

Form 2 – School Level Annex B.2

NATIONAL SCHOOL DEWORMING DAY

Region: ______________ Division: ________________________ District: ______________________________

School ID: ________________________________________________________
Name of School: ___________________________________________________

NO. OF CHILDREN
ENROLMENT DEWORMED
GRADE LEVEL Non- REMARKS
4P’s Non- 4P’s 4P’s
4P’s
 KINDER
GRADE I
GRADE II
GRADE III
GRADE IV
GRADE V
GRADE VI
TOTAL

Accomplished by: Noted by:

_________________________________ ___________________________________
School Principal District Supervisor

Date Accomplished: ____________________________