Page 1

BADAC DATA CAPTURE FORM 1

INDICATOR POSITION FIRST NAME LAST NAME SEX BIRTHDATE CIVIL STATUS ADDRESS CONTACT #
Chairperson /
NIÑA ASIS FEMALE P-12, POBLACION
Punong Barangay
Vice-Chairperson /
Peace & Order RENATO MONTERA MALE MARRIED P-16, POBLACION
Committee Chair
Members:
Chair of Women
& Family IMELDA YANGSON FEMALE MARRIED P-24, POBLACION
Committee
BADAC is
SK Chairperson SEAN FLITCHER ERAMIS MALE SINGLE P-12, POBLACION
composed of
seven (7) School Principal /
members MINDA TEPOSO FEMALE MARRIED P-5, TAGLATAWAN
Representative
Brgy Chief Tanod EDWIN POLINAR MALE MARRIED P-2, POBLACION
NGO / CSO
GEORGE CUTURA MALE MARRIED P-4A, POBLACION
Representative
Faith-based Org
TEREZO LANZON JR. MALE MARRIED P-20, POBLACION
Representative
Adviser:
Local PNP
Chief / JAIME EDEJER MALE MARRIED P-12, POBLACION
Representative
Chairperson / Peace
& Order Committee RENATO MONTERA MALE MARRIED P-16, POBLACION
BADAC Chair
Committee on Members:
Operations is
organized Brgy Chief Tanod EDWIN POLINAR MALE MARRIED P-2, POBLACION
BADAC Auxiliary
Refer to BADAC Auxiliary Team Profile
Team
Chairperson /
Women & Family IMELDA YANGSON FEMALE MARRIED P-24, POBLACION
Committee Chair
Members:
BADAC SK Chairperson SEAN FLITCHER ERAMIS MALE SINGLE P-12, POBLACION
Committee on
Advocacy is School Principal /
MINDA TEPOSO FEMALE MARRIED P-5, TAGLATAWAN
organized Representative
NGO / CSO
GEORGE CUTURA MALE MARRIED P-4A, POBLACION
Representative
 Faith-based Org
TEREZO LANZON JR. MALE MARRIED P-20, POBLACION
Representative
Page 2
BADAC DATA CAPTURE FORM 1

INDICATOR POSITION FIRST NAME LAST NAME SEX BIRTH DATE CIVIL STATUS ADDRESS CONTACT #
REFER TO EXECUTIVE ORDER

BADAC
Auxiliary Team
(BAT) is
organized

REFER TO EXECUTIVE ORDER

Note: Use additional page if necessary. BAT shall be composed of one member per 80 residents; 25 members per 2,000 residents.
INDICATOR UNIT OF CLUSTER FIRST NAME LAST NAME SEX BIRTH DATE CIVIL STATUS ADDRESS CONTACT #

BADAC House
Clusters are
organized

Note: Use additional page if necessary. Examples of Unit of Cluster are by purok, by sitio, by block, by zone, by street, etc.
CONCURRENT
INDICATOR DESIGNATION FIRST NAME LAST NAME SEX BIRTH DATE CIVIL STATUS ADDRESS CONTACT #
(if applicable)
Barangay Duty
Officers are
designated
Barangay Duty
Officers are
designated
Note: Use additional page if necessary. Concurrent Designation refers to the primary appointment / item of the designated Brgy Duty Officer in the barangay, e.g. Barangay
Health Worker, VAWC Desk Officer, etc.
 Page 3
BADAC DATA CAPTURE FORM 2
DURATION SPEAKER /
INDICATOR ACTIVITY TITLE VENUE LEAD ORGANIZER
DATE (MM/DD/YYYY) TIME FACILITATOR
Provincial Roll-out Training and
Trainings Attended Orientation on Strengthening of Sept. 06, 2018 Mabe's Savory Place
by Punong BADAC on Barangay Drug Clearing San Francisco, ADS
Barangay on
Strengthening Program
BADACs

Note: Use additional page if necessary.

DURATION SPEAKER /
INDICATOR ACTIVITY TITLE VENUE LEAD ORGANIZER
DATE (MM/DD/YYYY) TIME FACILITATOR

Trainings /
Planning Session
Attended by
Punong Barangay
on CSAR

Note: Use additional page if necessary.

NO. OF
DURATION SPEAKER /
INDICATOR ACTIVITY TITLE VENUE PARTICIPANTS
DATE (MM/DD/YYYY) TIME FACILITATOR MALE FEMALE

Trainings
Conducted by
BADAC for House
Cluster Leaders

Note: Use additional page if necessary.

NO. OF
DURATION SPEAKER /
INDICATOR ACTIVITY TITLE VENUE PARTICIPANTS
DATE (MM/DD/YYYY) TIME FACILITATOR MALE FEMALE

Trainings
Conducted by
BADAC for BADAC
Auxiliary Team

Note: Use additional page if necessary.

DURATION SPEAKER /
INDICATOR ACTIVITY TITLE VENUE LEAD ORGANIZER
DATE (MM/DD/YYYY) TIME FACILITATOR

Trainings Attended
by Barangay Duty
Officers

Note: Use additional page if necessary.

 Page 4
BADAC DATA CAPTURE FORM 3

DURATION NO. OF PARTICIPANTS

INDICATOR ACTIVITY TITLE VENUE PRESIDING OFFICER
DATE (MM/DD/YYYY) TIME MALE FEMALE

Conduct of BADAC MEETING May 18, 2019 Barangay Hall

BADAC
Consultative
Meetings

Note: Use additional page if necessary.

DURATION NO. OF PARTICIPANTS
INDICATOR ACTIVITY TITLE VENUE PRESIDING OFFICER
DATE (MM/DD/YYYY) TIME MALE FEMALE

BADAC Monthly Meeting Jan. 21, 2019 Barangay Hall

BADAC Monthly Meeting May 18, 2019 Barangay Hall
BADAC Monthly Meeting Jul. 09, 2019 Barangay Hall
Conduct of
BADAC Monthly
Meetings

Note: Use additional page if necessary.

DURATION NO. OF PARTICIPANTS
INDICATOR ACTIVITY TITLE VENUE TARGET AUDIENCE
DATE (MM/DD/YYYY) TIME MALE FEMALE

Organization/Co-
organization of
Community-based
IEC Campaign
Activities

Note: Use additional page if necessary.

DURATION NO. OF PARTICIPANTS
INDICATOR ACTIVITY TITLE VENUE TARGET AUDIENCE
DATE (MM/DD/YYYY) TIME MALE FEMALE

Organization/Co-
organization of
School-based IEC
Campaign
Activities

Note: Use additional page if necessary.

 Page 5
BADAC DATA CAPTURE FORM 3

DURATION NO. OF PARTICIPANTS

INDICATOR ACTIVITY TITLE VENUE TARGET AUDIENCE
DATE (MM/DD/YYYY) TIME MALE FEMALE

Conduct of Youth-
led IEC Campaign
Activities

Note: Use additional page if necessary.

DURATION NO. OF PARTICIPANTS
INDICATOR ACTIVITY TITLE VENUE TARGET AUDIENCE
DATE (MM/DD/YYYY) TIME MALE FEMALE

Conduct of CSO-
led IEC Campaign
Activities

Note: Use additional page if necessary.

DURATION NO. OF PARTICIPANTS
INDICATOR ACTIVITY TITLE VENUE TARGET AUDIENCE
DATE (MM/DD/YYYY) TIME MALE FEMALE

Organization/Co-
organization of
Activities in
Observance of the
IDADAIT

Note: Use additional page if necessary.

DURATION NO. OF PARTICIPANTS
INDICATOR ACTIVITY TITLE VENUE TARGET AUDIENCE
DATE (MM/DD/YYYY) TIME MALE FEMALE

Organization/Co-
organization of
Activities in
Observance of the
DAPC Week

Note: Use additional page if necessary.

 Page 6
BADAC DATA CAPTURE FORM 4
UNIFIED BARANGAY REPORT ON REFERRAL ACTION (UBRRA)

Data provided herein are those recorded within the months of: January to June ( ) July to December ( ) Year (YYYY): __________________________

NO. OF SURRENDERERS NO. OF REFERRED SURRENDERERS

INDICATOR INDICATOR
MALE FEMALE MALE FEMALE
TOTAL TOTAL
BELOW 18 ABOVE 18 BELOW 18 ABOVE 18 BELOW 18 ABOVE 18 BELOW 18 ABOVE 18

Submission of Updated
Submission of Updated Number
Number of Residents who
of Referred Surrenderers
Surrenderred

NO. OF SURRENDERERS ENROLLED IN WELLNESS &

STATUS / STATUS AND NO. OF ASSESSED SURRENDERERS WELLNESS & RECOVERY INTERVENTIONS
INDICATOR LEVEL OF INDICATOR RECOVERY
RISK MALE FEMALE INTERVENTIONS MALE FEMALE
TOTAL TOTAL
BELOW 18 ABOVE 18 BELOW 18 ABOVE 18 BELOW 18 ABOVE 18 BELOW 18 ABOVE 18

General
Low
Interventions

Community-based
Mild Submission of Treatment &
Submission of Rehab
Updated
Updated Number
Number of
of Assessed Health Facility-
Enrolled
Surrenderers
Moderate Surrenderers based Outpatient
Treatment &
Rehab

Inpatient
Severe Treatment &
Rehab

NO. OF SURRENDERERS WHO COMPLETED WELLNESS &

RECOVERY INTERVENTIONS The purpose of this form is to determine the number of surrenderers per semester (January-
INDICATOR June, July-December), and monitor the number of who, among those surrenderers, have
MALE FEMALE been referred, assessed, and who have completed any Wellness and Recovery Program
TOTAL
BELOW 18 ABOVE 18 BELOW 18 ABOVE 18 interventions within the 6-month time frame. Counting shall restart at the onset of the new
Submission of Updated semester; meaning, the data on those who surrendered in the previous semester shall no
Number of Surrenderers Who longer be accounted in the next, regardless of whether they have been referred or assessed
Completed Wellness & in the following semester.
Recovery Interventions
 Page 7
BADAC DATA CAPTURE FORM 5
COMMUNITY SUPPORT, AFTERCARE AND REINTEGRATION (CSAR)

Data provided herein are those recorded within the months of: January to June ( ) July to December ( ) Year (YYYY): __________________________

NO. OF CSAR ENROLLEES NO. OF CSAR GRADUATES

INDICATOR INDICATOR
MALE FEMALE MALE FEMALE
TOTAL TOTAL
BELOW 18 ABOVE 18 BELOW 18 ABOVE 18 BELOW 18 ABOVE 18 BELOW 18 ABOVE 18
Submission of
Submission of Updated Updated Number of
Number of Residents Residents Who
Enrolled in CSAR Program, Completed the
or its equivalent CSAR Program, or
its equivalent

The purpose of this form is to determine the number of residents enrolled in CSAR Program, or its equivalent, per semester (January-June, July-December), and monitor the number of
who, among those enrolled, have completed the CSAR program within the 6-month time frame. Counting shall restart at the onset of the new semester; meaning, the data on those
enrolled in the previous semester shall no longer be accounted in the next, regardless of whether they have been referred or assessed in the following semester.
 Page 8
BADAC DATA CAPTURE FORM 6
SUMMARY OF CONSOLIDATED INFORMATION REPORT
as per Section 8 of DDB Board Regulation No. 3, s. 2017
Year (YYYY): _________

Data provided herein are those recorded within the months of: January to March ( ) April to June ( ) July to September ( ) October to December ( )

DRUG SUPPLY DRUG TRANSIT / CLANDESTINE

DRUG PUSHER DRUG USER / DEPENDENT
INDICATOR AVAILABILITY TRANSHIPMENT ACTIVITY LABORATORY

PRESENT / ABSENT TOTAL PRESENT / ABSENT TOTAL PRESENT/ABSENT PRESENT/ABSENT PRESENT/ABSENT

Submission of
Updated Summary of CLANDESTINE CHEMICAL MARIJUANA CULTIVATION DRUG DEN, DIVE OR DRUG PROTECTOR /
CLANDESTINE DRUG WAREHOUSE
Consodated WAREHOUSE SITE / PLANTATION RESORT CODDLER & FINANCIER
Information Report
(CIR)

PRESENT/ABSENT PRESENT/ABSENT PRESENT/ABSENT PRESENT/ABSENT PRESENT/ABSENT