Form 2 - School Level (per grade)

NATIONAL SCHOOL DEWORMING MONTH (FINAL REPORT)

Region: Division: District:

School ID: Name of School:

No. of Enrolled Children No. of Dewormed Children

Grade Level Remarks
4Ps Non-4Ps Total 4Ps Non-4Ps Total

TOTAL

Accomplished by: Noted by:

School NSDD Point Person School Head

Date Accomplished:
 NATIONAL SCHOOL DEWORMING MONTH (FINAL REPORT)

Region: Division: District:

School ID: Name of School:

No. of Current Personnel No. of Dewormed Personnel

Personnel
Male Female Total Male Female Total
Teaching
Non-Teaching
Canteen Personnel

TOTAL

Accomplished by: Noted by:

School NSDD Point Person

Date Accomplished:
PORT)

Remarks

School Head
 NATIONAL SCHOOL DEWORMING MONTH
Monitoring Tool

Region: ___________________ Division: District: ____________________

School ID: _____________________ Name of School: ________________________________________________

Adverse Events following Deworming (signs

Name of Child Age Grade Level Action Taken
and symptoms)

Accomplished by: Noted by:

School NSDD Point Person School Head