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VAC Form 1

BARANGAY DATA CAPTURE FORM


MONITORING OF INCIDENCE ON VIOLENCE AGAINST CHILDREN (VAC) DURING THE COVID-19 PANDEMIC
For the period: February 1 - 28, 2020

Region: IV-A CALABARZON_


Province: BATANGAS
City/Municipality: LEMERY
Barangay: DISTRICT I

GENDER TYPES OF VIOLENCE PERPETRATORS ACTIONS TAKEN BY THE BARANGAY/BCPC


VAC (2) (4) Immediate (5) Referred
(6) for Referred Others
AGE Physical Sexual Psychological/ Other Close Local Law Others Referred Referred Referred
VICTIM/S Male Female Neglect Family Acquaintance Stranger Medical for Legal (ex: Referred to
(3) Abuse Abuse Emotional Abuse Relative Official Enforcer (ex: Guardian) to LSWDO to PNP to NBI
(1) (2a) (2b) (4d) Member (5c) (5d) Treatment Assistance NGOs, FBOs)
✔=1 ✔=1 ✔(4a)
=1 (4b)
✔=1 (4c)
✔=1 ✔=1 ✔(5a)
=1 ✔(5b)
=1 ✔=1 ✔=1 ✔(5e)
=1 ✔(5f)
=1 pls. (5g)
specify ✔(6a)
=1 ✔(6b)
=1 ✔(6c)
=1 ✔(6d)
=1 ✔(6e)
=1 pls. (6f)
specify
Child 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Child 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Child 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

TOTAL 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
*If ✔, encode "1" on the applicable fields *Immediate Family Member/s – parents and siblings
*If "Others," please specify *Other Close Relative/s – uncles, aunts, grandparents, cousins, etc.

Submitted by: CRISTINA M. MASUPIL


Punong Barangay

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