DIVISION MONITORING TOOL ON REPORTED INCIDENTS OF CHILD ABUSE

Legislative District: ______________________________ Number of Schools Monitored: ____________________________

_____ 1st QTR _____2nd QTR _____ 3rd QTR _____4th QTR
Name of LD Focal Person: ________________________ Period of Monitoring: (January 2020 – December 2020)

Action
Name of Type of Abuse Taken Status of Case
Name of Learner Sex (Verbal/Emotional/Physical/Sexua Recommendation Remarks
District l etc) (Include (Pending/Resolved)
Dates)

Note to the counselor: Ensure proper documentation of incidents through Intake sheets and referral forms.

Prepared by: _____________________________

Guidance Counselor
 Noted by: ________________________________
Division Guidance Counselor Designate

DIVISION MONITORING TOOL ON REPORTED INCIDENTS OF CHILD ABUSE

SUMMARY OF LEGISLATIVE DISTRICT REPORT

Legislative District: ______________________________ Number of Schools Monitored: ____________________________

Name of LD Focal Person: ________________________ Period of Monitoring: (September 2021 – November 2021)

Type of Abuse Total Number of Status of Case

Remarks
Name of Reported Incidents (Pending/Resolved)
District Verbal Emotional Physica Sexual Others
l

Note to the counselor: Ensure proper documentation of incidents through Intake sheets and referral forms.
Prepared by: _____________________________
Guidance Counselor

Noted by: ________________________________

Division Guidance Counselor Designate