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2. Answer all PRE-ASSESSMENT INDICATORS with YES or NO only (except for mode of transportation).
4. Supply what is asked for VACCINATION STATUS with FIGURES only (except for reasons for unvaccination).
5. Avoild leaving any column unfilled and altering any of the pre-set cells.
6. Prior to the cut off date, members of the Composite Team should have VALIDATED the responses in each
column. Submit an APPROVED and SIGNED copy of the sheet to pprd.ro3@deped.gov.ph on or before each cycle cut-off date.
Thank You and stay safe!
Republic of the Philippines
DEPARTMENT OF EDUCATION REGION 3
Matalino St. D.M. Government Center, Maimpis, City of San Fernando (P)
REGION-WIDE SCHOOL SAFETY ASSESSMENT
SCHOOL PROFILE PRE-ASSESSMENT Q
For the past twenty-eight
(28) days, has the
barangay where your
school is located recorded
any confirmed COVID-19
case/s? *Kindly refer to
your respective barangay
for the data.
School ID School Name Name of School Head School Contact Number
Malinao Elementary
105310
School
Pagsangjan Elementary
159004
School LUCENA D. NANGAN 9359347650 NO
Vaidated:
o
YES
Referral and follow-up of YES YES YES YES
learners, teachers, and
personnel to appropriate
facilities
k. Reiteration of l. Record of students’ 2. The school has a. Cooperation with
protocols for learners, health status and identified strategies to the local health authorities
teachers, and personnel development, including detect COVID-19. in the tracing and
who manifest COVID-19 immunization checks to quarantine of close
symptoms to not physically prevent outbreak-prone contacts of confirmed
report to school and seek vaccine-preventable cases of COVID-19
medical advice virtually if disease (e.g., measles consistent with DOH
possible guidelines
o DOH
Regional ESU of identified
case (place of residence)
o
LGU City ESU/Provincial
ESU/Municipal ESU of
YES YES
identified case (place of YES YES
residence)
3. The school has a. Designation of b. Availability of c. Notification of family d. Immediate isolation
developed strategies to rooms for isolation of transport vehicles from member/guardians of the and referral of the
isolate and treat COVID- students and personnel school to Temporary learner, or family member personnel/s or learner/s
19. with fever and flu-like Treatment and Monitoring of school personnel who who show COVID-19
symptoms near the Facility (TTMF) show flu-like symptoms symptoms based on the
entrances severity for proper
management and
appropriate testing
YES YES NO NO
d. distressed e.low resourced students f. abandoned and g.street children h.children of former rebels
individuals and families, neglected children
including internally
displaced persons (IDPs)
NO YES NO NO NO
i. children living in j. children with k. children from 2. The school has a. Inclusion of learners
conflict-affected areas and disabilities and SPED Geographically Isolated identified learners who are who need assistive
vulnerable communities students and Disadvantaged Areas most vulnerable and devices that do not require
(CVAS) disadvantaged in terms of them to remove their face
access to learning as masks
indicated in the eligibility of
learners, such as inclusion
of:
NO NO YES NO
b. Coordination with c. Ensured that 3. The school has developed learning 4. The school has ensured participation
partner agencies in the parent/guardian of learners strategies to cater the needs of the in school-based services which includes but
provision of assistive are informed that his/her disadvantaged learners such as modules in is not limited to feeding and nutrition
devices such as child has their own braille, mother-tongue languages, and usage programs, immunizations, Mental Health and
wheelchairs, cane, assistive device during of Filipino Sign Language. Psychosocial Support (MHPSS), prevention
walkers, and others face-to-face classes of Violence against Children (VAC) (i.e.,
bullying from social stigma) and other health
services.
NO NO YES YES
5. The school has established close 6. The school has a. Routine b. Facilitation of the completion of
coordination with the Department of Social coordinated with their implementation of SBI routine immunizations through regular
Welfare and Development (DSWD) Case respective local together with school health immunization mechanisms available through
Managers of those learners who are government units with the services among target the National Immunization Program (NIP)
marginalized; Other partner agencies and implementation of routine learners
organizations such as National Council on school-based
Disability Affairs (NCDA). immunization (SBI) and
other school health-related
services such as but not
limited to deworming and
weekly iron-folate acid
supplementation (WIFA).
YES 2 4 0 0
VACCINATION STATUS
Total Number of Fully Total Number of Male and % of Fully Vaccinated Number of Unvaccinated Reasons for Unvaccination
Vaccinated Male and Female Teaching Teaching Personnel Male and Female
Female Teaching Personnel Teaching Personnel
Personnel
6 6 100% 0
VACCINATION STATUS
Number of Fully Number of Fully Number of Vaccinated (1st Number of Vaccinated (1st Total Number of Fully
Vaccinated Male Non- Vaccinated Female Non- Dose Only) Male Non- Dose Only) Female Non- Vaccinated Male and
Teaching Personnel Teaching Personnel Teaching Personnel Teaching Personnel Female Non-Teaching
Personnel
0 0 0 0 0
Total Number of Male and % of Fully Vaccinated Non- Number of Unvaccinated Reasons for Unvaccination
Female Non-Teaching Teaching Personnel Male and Female Non-
Personnel Teacing Personnel