VAW Form 1

BARANGAY DATA CAPTURE FORM

MONITORING OF INCIDENCE ON VIOLENCE AGAINST WOMEN (VAW) DURING THE COVID-19 PANDEMIC
For the period: March 16, 2020 - May 15, 2020

Region:___ III
Province:_________ BULACAN
City/Municipality:_ PAOMBONG
Barangay:________ KAPITANGAN

VAW TYPES OF VIOLENCE (2) ACTIONS TAKEN BY THE

Referred forBARANGAY
Referred(3)
for Others
Physical Psychological/ Economic Referred to Referred to Referred to Referred to
VICTIM/S Sexual Abuse Issued BPO Medical Legal (ex: Referred to
Abuse Emotional Abuse Abuse LSWDO PNP NBI Court
(1) (2b) (3a) Treatment Assistance NGOs, FBOs)
✔(2a)
=1 ✔=1 ✔(2c)
=1 (2d)
✔ =1 ✔=1 ✔(3b)
=1 ✔(3c)
=1 ✔(3d)
=1 ✔(3e)
=1 ✔(3f)
=1 ✔(3g)
=1 pls. (3h)
specify
Victim 1

Victim 2

Victim 3

TOTAL

*If ✔, encode "1" on the applicable fields

*If "Others," please specify

Submitted by:
Punong Barangay
VAW Form 1
BARANGAY
MONITORING OF INCIDENCE ON VIOLENCE DATA CAPTURE
AGAINST WOMEN FORM(VAW) DURING THE COVID-19
PANDEMIC
For the period: DECEMBER 01-31, 2021

Region:__ III
Province:_______ ZAMBALES
City/Municipality IBA
Barangay:_______SAN AGUSTIN

TYPES OF VIOLENCE (2) ACTIONS TAKEN BY THE BARANGAY (3)

Referred for Referred for Others

VAW VICTIM/S Physical Sexual Psychological/ Economic Referred to Referred to Referred to Referred to
Issued BPO Medical Legal (ex: Referred to NGOs,
(1) Abuse Abuse Emotional Abuse Abuse LSWDO PNP NBI Court
(3a) Treatment Assistance FBOs)
(2a) (2b) (2c) (2d) (3b) (3c) (3d) (3g)
(3e) (3f) (3h)

✔=1 ✔=1 ✔=1 ✔=1 ✔=1 ✔=1 ✔=1 ✔=1 ✔=1 ✔=1 ✔=1 pls. specify

NEZREEL BELEN M.
MONTEFALCON

TOTAL ✔=1 ✔=1

*If ✔, encode "1" on the applicable fields

*If "Others," please specify

Submitted by: EDITH A. MONTEFALCON

Punong Barangay