Republic of the Philippines

Department of Education
Region V – Bicol

DCP INCIDENT REPORT FORM

1 School: Division:
School ID: School Head:
2 ICT Coordinator: Property Custodian:

DCP Batch: Supplier: Date of Incident:

Type of Incident (Click or Tap on the appropriate Check boxes)
3 DELIVERY ISSUES INSTALLATION ISSUES TRAINING/ACCEPTANCE
 Did not deliver on site Package/s not completely ISSUES
 Delivered after 5pm installed  Did not meet required
 Delivered during  Package/s not securely number of training hours
weekend/holiday installed  Training checklist not
followed
 Incomplete delivery of  Items installed are defective
materials and/or equipment  Some Items are missing
 Package container/s not  Do not have installation POST-ACCEPTANCE
sealed properly equipment ISSUES
 Item/s found defective
 Other issue (specify):
Details of the Issue
4

Action Taken by the school

5

6 Reported by: Attested by:

ICT Coordinator School Head

SDO’s Action
7 Click or tap here to enter text.

8 Reviewed by: Noted by:

Information Technology Officer I Schools Division Superintendent