VAC Form 1

BARANGAY DATA CAPTURE FORM

MONITORING OF INCIDENCE ON VIOLENCE AGAINST CHILDREN (VAC) DURIN
For the period: October 1, 2021 - October 31, 2021

Region: IV-A
Province: RIZAL
City/Municipality: PILILLA
Barangay: HALAYHAYIN

GENDER TYPES OF VIOLENCE PERPETRATORS

VAC (2) (4) Immediate (5)
AGE Physical Sexual Psychological/ Other Close Local Law
VICTIM/S Male Female Neglect Family Acquaintance Stranger
(3) Abuse Abuse Emotional Abuse Relative Official Enforcer
(1) (2a) (2b) (4d) Member (5c) (5d)
✔=1 ✔=1 ✔(4a)
=1 (4b)
✔=1 (4c)
✔=1 ✔=1 ✔(5a)
=1 ✔(5b)
=1 ✔=1 ✔=1 ✔(5e)
=1 ✔(5f)
=1
Child 1 0 0 0 0 0 0 0 0 0 0 0 0 0

TOTAL
*If ✔, encode "1" on the applicable fields *Immediate Family Member/s – parents and siblings
*If "Others," please specify *Other Close Relative/s – uncles, aunts, grandparents, cousins, etc.

Submitted by:
 FORM
N (VAC) DURING THE COVID-19 PANDEMIC
31, 2021

ACTIONS TAKEN BY THE BARANGAY/BCPC

Referred
(6) for Referred for Others
Others Referred to Referred Referred
Medical Legal (ex: Referred to
(ex: Guardian) LSWDO to PNP to NBI
Treatment Assistance NGOs, FBOs)
pls. (5g)
specify ✔(6a)
=1 ✔(6b)
=1 (6c)
✔=1 ✔(6d)
=1 ✔(6e)
=1 pls. (6f)
specify
0 0 0 0 0 0 0

REYNATO G. JUAN
Punong Barangay