ANNEX C

Form I
National School Deworming Day
Deworming Checklist

Province: MISAMIS ORIENTAL

Division: MISAMIS ORIENTAL
District: ALUBIJID
Name of School: LUMBO ELEMENTARY SCHOOL
School Address: LUMBO , ALUBIJID , MISAMIS ORIENTAL
Total Enrollment: 33
Grade Level and Section: GRADE I – HONESTY

GENDER HAND TOOTH

FEEDING ACTION
NAME OF CHILD AGE WASHING DONE
DEWORMED BRUSHING REMARKS
TAKEN
M F DONE DONE

9
1
0
1
1
1
2
1
3
1
4
1
5
1
6
1
7
1
8
1
9
2
0
2
1
2
2
 2
3
2
4
2
5
2
6
2
7
2
8
2
9
3
0
3
1
3
2

3
3

Accomplished By:

Noted By:

Class Adviser:

JOY LYNN ESTRADA JANICE LOURDES S. RESURRECCION

Grade Level Adviser Principal

Date Accomplished: November 9, 2018