Page 1

BADAC DATA CAPTURE FORM 1

CIVIL
INDICATOR POSITION FIRST NAME LAST NAME SEX BIRTHDATE ADDRESS CONTACT #
STATUS
Chairperson /
Punong Barangay
Vice-Chairperson /
Peace & Order
Committee Chair
Members:
Chair of Women &
Family Committee
BADAC is SK Chairperson
composed of
School Principal /
seven (7)
Representative
members
Brgy Chief Tanod
NGO / CSO
Representative
Faith-based Org
Representative
Adviser:
Local PNP Chief /
Representative
Chairperson /
Peace & Order
BADAC Committee Chair
Committee on Members:
Operations is
organized Brgy Chief Tanod
BADAC Auxiliary
Refer to BADAC Auxiliary Team Profile
Team
Chairperson /
Women & Family
Committee
Members: Chair
BADAC
Committee on SK Chairperson
Advocacy is School Principal /
organized Representative
NGO / CSO
Representative
Faith-based Org
Representative
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BADAC DATA CAPTURE FORM 1
 INDICATOR POSITION FIRST NAME LAST NAME SEX BIRTH DATE CIVIL STATUS ADDRESS CONTACT #

BADAC
Auxiliary Team
(BAT) is
organized

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 #
Barangay Duty (if applicable)
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.
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BADAC DATA CAPTURE FORM 2
DURATION SPEAKER /
INDICATOR ACTIVITY TITLE VENUE LEAD ORGANIZER
DATE (MM/DD/YYYY) TIME FACILITATOR

Trainings Attended
by Punong
Barangay on
Strengthening
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.
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BADAC DATA CAPTURE FORM 3
NO. OF
DURATION PRESIDING
INDICATOR ACTIVITY TITLE VENUE PARTICIPANTS
DATE (MM/DD/YYYY) TIME OFFICER MALE FEMALE

Conduct of
BADAC
Consultative
Meetings

Note: Use additional page if necessary.

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

Conduct of
BADAC Monthly
Meetings

Note: Use additional page if necessary.

NO. OF
DURATION
INDICATOR ACTIVITY TITLE VENUE TARGET AUDIENCE PARTICIPANTS
DATE (MM/DD/YYYY) TIME MALE FEMALE
Organization/Co-
organization of
Community-
based IEC
Campaign
Activities
Note: Use additional page if necessary.
NO. OF
DURATION
INDICATOR ACTIVITY TITLE VENUE TARGET AUDIENCE PARTICIPANTS
DATE (MM/DD/YYYY) TIME MALE FEMALE

Organization/Co-
organization of
School-based IEC
Campaign
Activities
Note: Use additional page if necessary.
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BADAC DATA CAPTURE FORM 3
NO. OF
DURATION
INDICATOR ACTIVITY TITLE VENUE TARGET AUDIENCE PARTICIPANTS
DATE (MM/DD/YYYY) TIME MALE FEMALE

Conduct of Youth-
led IEC Campaign
Activities

Note: Use additional page if necessary.

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

Conduct of CSO-
led IEC Campaign
Activities

Note: Use additional page if necessary.

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

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

Note: Use additional page if necessary.

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

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

Note: Use additional page if necessary.

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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 : 2019

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 of Residents who Number of Referred
Surrenderred Surrenderers

WELLNESS & NO. OF SURRENDERERS ENROLLED IN WELLNESS &

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

General
Low
Interventions

Community-
Mild Submission of based Treatment
Submission of & Rehab
Updated
Updated Number
Number of
of Assessed Health Facility-
Enrolled
Surrenderers based Outpatient
Moderate Surrenderers
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 been
MALE FEMALE
TOTAL referred, assessed, and who have completed any Wellness and Recovery Program
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 in
Completed Wellness & the following semester.
Recovery Interventions
 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 in
Completed Wellness & 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
Number of Residents of 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 DRUG PROTECTOR /

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

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