Republic of the Philippines

Department of Education
Region 02 (Cagayan Valley)
SCHOOLS DIVISION OFFICE OF ISABELA
Alibagu, City of Ilagan, Isabela 3300
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2019 Clean-Up Drive (Todas Dengue, Todo Na ‘To-Ika-anim Na Kagat)

Monitoring and Evaluation Form

SCHOOL ID: 103869 Name of School: San Roque Elementary School District: Santo Tomas Date: July 26, 2019

A. Volunteer Groups Number of Volunteers Remarks

1. Parents
2. Alumni
3. LGU Volunteers
4. NGO
5. Others
TOTAL

B. Dengue Preventive Measures Evident Not Remarks

Evident
1. Removal of stagnant water in items
that collect rainwater.
2. Water containers are properly
covered and stored under shelter.
3. Getting rid of sources of areas where
mosquitoes breed, such as standing
water in flower pots, tins, bottles or
discarded tires.
4. Presence of appropriate insecticides
such as larvicides to prevent
mosquitoes from breeding.
5. Drains are unclogged along corridors
to ensure they are not blocked
especially during rainy season.
6. Plant pot plates are free from water
7. Potted plants are cultivated to prevent
the accumulation of stagnant water
on the surface of the hardened soil.
8. Absence of possible mosquito
breeding places such as used tires,
drums, discarded buckets and tin
cans.
9. Roof gutters are free from clogs like
fallen leaves, among others.
10. Presence of indoor and outdoor plants
that are mosquito repellant
11. Conducted school fumigation to drive
away mosquitoes.

(078) 323-0281 Sdo Isabela Document Code: FM-ORD-00

(078) 323-2015 https://deped-isabela.com.ph Rev.: 00
isabela@deped.gov.ph As of: 07-01-2019
 Republic of the Philippines
Department of Education
Region 02 (Cagayan Valley)
SCHOOLS DIVISION OFFICE OF ISABELA
Alibagu, City of Ilagan, Isabela 3300
_______________________________________________________________________________________________________________________________________

12. School surroundings are clean and

free from stagnant water, wild weeds
and other unwanted plants
13. Presence of Dengue Information and
IEC Materials for distribution.
14. Pruning/Trimming of Trees
15. Coordinated with the Local DRRM
Council/HDRRMC, Municipal
Health Office, BFP, NGOs and other
lead offices/agencies

C. Best Practices on School Clean-up Drive

___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

D. Comments and Suggestions

___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Monitored and Evaluated by:

___________________________
Name & Position

Conforme:

Rhodora T. Gumaru
School Head

(078) 323-0281 Sdo Isabela Document Code: FM-ORD-00

(078) 323-2015 https://deped-isabela.com.ph Rev.: 00
isabela@deped.gov.ph As of: 07-01-2019