Annex B.

1
Form 1- Classroom Level

NATIONAL SCHOOL DEWORMING MONTH

Deworming Checklist
Date: JULY 29, 2019 Month: JULY Year: 2019
Province: Surigao del Norte School Address: Roxas St., Brgy. Washing
Division: Surigao City Total Enrolment: 38
District: IV Grade/Section: 6 - Masayahin
Name of School: C.V. Diez Memorial Central Elementary School

Gender Hand Dewormed

Feeding
NO. Name of Child 4P's Washin Remarks
M F Done STH Filariasis
g Done
1 ANGOB, JOHN √ 09-10-2006
2 ARELLANO, AL JOHN √ 09-27-2007
3 AQUINO, JESSIERY √ 10-20-2007 √
4 ASPIRIN, REYMAR √ 11-12-2006 √
5 BECALA, TERRENCE CHAN √ 06-14-2007 √
6 BESINGA, JAMES LENNOX √ 07-20-2008
7 BIGCAS, JOHN √ 08-30-2007
8 BULACTIAL, MARK √ 01-22-2007 √
9 CABANERO, JOHN PAUL √ 08-02-2007

CORVERA,ALFRITZ GERALD,
10 √ 10-10-2006
LISONDRA

11 EBON, CARL ERICSON √ 3/9/2008

12 ESCOBAL, JB √ 12-07-2007
13 GALLEGO, STEVEN CHAN √ √
14 HADJI, CHISTER √ 12-03-2007 √
15 LOMAYNO, JOMARIE √ 08-08-2007 √
16 MAKINANO, JAYSON √ 02-28-2005
17 MAQUILING, RICO YAN √ 04-19-2008 √
18 PAREJA, JIAN √ 07-29-2008
19 PLACEROS, KURT JOSH √ 02-24-2008 √
20 PONO, SYDNEY √ 02-18-2006
21 TABADA, DHONALD √ 6/28/2008 √
22 TAMPARONG, HERNAN √ 08-21-2008 √
23 TORCAL, ALAN JOY √ 06-11-2008 √
24 ARMERO, SHEILA √ 09-18-2008

25 CANOY, TRIXIE √ 05-25-2005

EDER,CHRISTEL QUEEN,
26 √ 07-30-2008 √
FLORENO
27 FUGOSO, BLAIR MAE √ 01-25-2008

28 GA, MARIEL √ 02-11-2007 √

29 GUIRITAN, JASMINE √ 12-09-2007

30 LAON, ASHANTI √ 12-27-2007

31 PECASALES, SHECAN √ 08-22-2008

32 PETALLO, ALEXANDRIA √ 11-06-2007

33 SALVADOR, KYZLY √ 08-01-2008

34 SULTAN, JUNAILLAH √ 04-09-2008

35 SULTAN, ROSELAINE √ 06-21-2007

36 TIMKANG, JOY √ 11-23-2007 √

37 TORREGOZA, GRACE ANNE √ 05-03-2008

38 YBANYEZ, JOJANE VEVS √ 4/27/2008

Accomplished by: Noted by:

JOANNA PIA P. GALANIDA RICHARD B. ANTALLAN, PhD

Class Adviser (Print Name & Signature) Principal/OIC
Contact No.
Contact No. 09107480645
09107299520
ss: Roxas St., Brgy. Washington, S.C.

n: 6 - Masayahin

Actions
Taken

TALLAN, PhD
l/OIC