ANNEX C

FORM 1

National School Deworming Day

Deworming Checklist
Province: Name of School:
Division: School Address:
District: Total Enrollment:
Grade Level and Section:
Gender Hand
Name of Child Washing Feeding Dewormed Tooth Remarks
Done Done Brushing Actions
M F Done Taken

Acomplished by: Noted by:

_______________________________ _______________________________
Class Adviser Grade Level Adviser
 National School Deworming Day
School Level Reporting Form
Province: Masabate
Division: Masbate
District: Mobo South
Name of School: Bagacay Elementary School
School Address: Bagacay, Mobo, Maasbate
No. of Children Enrolled in the School: ____________________________

No. of Enrolled Children No. of Children Dewormed

Grade Level Remarks
M F T M F T

Kinder

Grade I

Grade II

Grade III

Grade IV

Grade V

Grade VI

Total

Accomplished by:

CHONA R. OCSING
School Principal
Date Accomplished_____________
Noted:

VICTORIA L. COS, Ph.D.

District Supervisor