Republic of the Philippines

Department of Education
Schools Division Office of Camarines Sur
Address Pili, Camarines Sur

INCIDENT REPORT FORM

TYPE OF INCIDENT: (vehicular accident, armed conflict, theft, harassment, bullying, flashlight,
abduction, crime, etc.)
COVID 19 CASE
INCLUSIVE DATE AND TIME OF INCIDENT: August 28 – September 7, 2021

EXACT LOCATION OF INCIDENT: Rolando R. Andaya Sr. Memorial High School

INVOLVED PERSON/S & SPECIFIC PARTICIPATION:

RHEUBEN BARRAMEDA PANGANIBAN, 33, Male, Teacher I, Grade 9, Tested Positive for COVID-
19

NARRATIVE DETAILS OF INCIDENT

August 28, 2021: Flu like symptoms (i.e. headache, weakness, colds and cough) manifested except
fever
August 29, 2021: Soreness of throat and loss of sense of smell and taste observed
August 30, 2021: Rashes were observed in the forearms, thighs, and legs. Reported flu to ADAS II.
Informed ADAS that I won’t be coming to school for the rest of the week. Isolated myself.
September 5, 2021: Informed ADAS that I had my antigen and swab test at the COVID-19 testing
center of LGU-Pasacao
September 6, 2021: Informed SH, that my antigen and swab test and that result will come out
anytime in 3-5 working days. Moreover, SH was informed that I am a close contact of the most recent
person who turned positive for COVID test last September 5, 2021.
September 7, 2021: At around 4:44 pm, I received a call from MESU-Pasacao that I tested positive
for COVID 19. Informed SH about my status and that I need to be on quarantine for 14 days. Informed
the school nurse of the matter. School nurse advised to complete the IR form.

Action Taken:

Action taken by the School:

Advised to complete Incident Report Form. The DRRM Coordinator ordered disinfection of the entire
school with the barangay officials.

RECOMMENDATIONS:
1. Disinfection of school
2. Conduct contact tracing
3. Advise the close contact to isolate
4. Monitor the health status of teachers. Etc.
5. Report to RHU for monitoring and possible rt-pcr test.

DATE PREPARED: September 8,2021 DATE RECEIVED:

PREPARED BY:

ARIANE I. LAGATIC
SDRRMC/OIC
REVIEWED BY: REVIEWED BY:

LOIDA N. NIDEA, CESO V

Schools Division Superintendent