S.Y.

2016 - 2017
Kinder Summary Report for Vision and Hearing Screening

Vision Screening

Vision Screening Male Female Total Remarks /

Recommendation
Passed 129 122 251
Failed 0 0 0
Total 129 122 251

Hearing Screening

Hearing Screening Male Female Total Remarks /

Recommendation
Passed 129 122 251
Failed 0 0 0
Total 129 122 251

Prepared By: Noted By:

SHERLEY B. CASIMERO_________ ERMA N. QUEJA______________

Name and Signature of Clinic Teacher Name and Signature of School Principal

Vision and Hearing Screening Report Form

 S.Y. 2016 - 2017
Grade 1 Summary Report for Vision and Hearing Screening

Vision Screening

Vision Screening Male Female Total Remarks /

Recommendation
Passed 202 202 404
Failed 1 0 1
Total 203 202 405

Hearing Screening
Hearing Screening Male Female Total Remarks /
Recommendation
Passed 203 202 405
Failed 0 0 0
Total 203 202 405

Prepared By: Noted By:

SHERLEY B. CASIMERO_________ ERMA N. QUEJA______________

Name and Signature of Clinic Teacher Name and Signature of School Principal

Vision and Hearing Screening Report Form

 S.Y. 2016 - 2017
Grade 2 Summary Report for Vision and Hearing Screening

Vision Screening

Vision Screening Male Female Total Remarks /

Recommendation
Passed 227 201 428
Failed 0 1 1
Total 227 202 429

Hearing Screening
Hearing Screening Male Female Total Remarks /
Recommendation
Passed 227 201 428
Failed 0 1 1
Total 227 202 429

Prepared By: Noted By:

SHERLEY B. CASIMERO_________ ERMA N. QUEJA______________

Name and Signature of Clinic Teacher Name and Signature of School Principal

Vision and Hearing Screening Report Form

 S.Y. 2016 - 2017
Grade 3 Summary Report for Vision and Hearing Screening

Vision Screening

Vision Screening Male Female Total Remarks /

Recommendation
Passed 202 196 398
Failed 10 14 24
Total 212 210 422

Hearing Screening

Hearing Screening Male Female Total Remarks /

Recommendation
Passed 212 210 422
Failed 0 0 0
Total 212 210 422

Prepared By: Noted By:

SHERLEY B. CASIMERO_________ ERMA N. QUEJA______________

Name and Signature of Clinic Teacher Name and Signature of School Principal

Vision and Hearing Screening Report Form

 S.Y. 2016 - 2017
Grade 4 Summary Report for Vision and Hearing Screening

Vision Screening

Vision Screening Male Female Total Remarks /

Recommendation
Passed 239 189 428
Failed 12 12 24
Total 251 201 452

Hearing Screening

Hearing Screening Male Female Total Remarks /

Recommendation
Passed 247 201 448
Failed 4 0 4
Total 251 201 452

Prepared By: Noted By:

SHERLEY B. CASIMERO_________ ERMA N. QUEJA______________

Name and Signature of Clinic Teacher Name and Signature of School Principal

Vision and Hearing Screening Report Form

 S.Y. 2016 - 2017
Grade 5 Summary Report for Vision and Hearing Screening

Vision Screening

Vision Screening Male Female Total Remarks /

Recommendation
Passed 198 189 387
Failed 5 17 22
Total 203 206 409

Hearing Screening

Hearing Screening Male Female Total Remarks /

Recommendation
Passed 203 203 406
Failed 1 2 3
Total 204 205 409

Prepared By: Noted By:

SHERLEY B. CASIMERO_________ ERMA N. QUEJA______________

Name and Signature of Clinic Teacher Name and Signature of School Principal

Vision and Hearing Screening Report Form

 S.Y. 2016 - 2017
Grade 6 Summary Report for Vision and Hearing Screening

Vision Screening

Vision Screening Male Female Total Remarks /

Recommendation
Passed 184 164 348
Failed 8 14 22
Total 192 178 370

Hearing Screening

Hearing Screening Male Female Total Remarks /

Recommendation
Passed 191 177 368
Failed 1 1 2
Total 192 178 370

Prepared By: Noted By:

SHERLEY B. CASIMERO_________ ERMA N. QUEJA______________

Name and Signature of Clinic Teacher Name and Signature of School Principal

Vision and Hearing Screening Report Form

 S.Y. 2016 - 2017
Kinder to Grade Six Summary Report for Vision and Hearing Screening

Vision Screening

Vision Screening Male Female Total Remarks /

Recommendation
Passed 1,381 1,263 2,644
Failed 36 58 94
Total 1,417 1,321 2,738

Hearing Screening

Hearing Screening Male Female Total Remarks /

Recommendation
Passed 1,411 1,317 2,728
Failed 6 4 10
Total 1,417 1,321 2,738

Prepared By: Noted By:

SHERLEY B. CASIMERO_________ ERMA N. QUEJA______________

Name and Signature of Clinic Teacher Name and Signature of School Principal

Vision and Hearing Screening Report Form

 Vision and Hearing Screening Report
S.Y. 2016-2017

Prepared by: Noted by:

SHERLEY B. CASIMERO ERMA N. QUEJA
Clinic – in – Charge Principal II

Vision and Hearing Screening Report Form