Republic of the Philippines

Department of Education
REGION I
SCHOOLS DIVISION OFFICE I PANGASINAN
Binmaley I District
PARAYAO NATIONAL HIGH SCHOOL
SY 2021-2022

LIST OF VACCINATED TEACHERS

Vaccinated Dose Received (Date)
Name Reason why unvaccinated
Yes No 1st 2nd / Full

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐
 Republic of the Philippines
Department of Education
REGION I
SCHOOLS DIVISION OFFICE I PANGASINAN
Binmaley I District
PARAYAO NATIONAL HIGH SCHOOL
SY 2021-2022

Vaccinated Dose Received (Date)

Name Reason why unvaccinated
Yes No 1st 2nd / Full

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐
 Republic of the Philippines
Department of Education
REGION I
SCHOOLS DIVISION OFFICE I PANGASINAN
Binmaley I District
PARAYAO NATIONAL HIGH SCHOOL
SY 2021-2022

Vaccinated Dose Received (Date)

Name Reason why unvaccinated
Yes No 1st 2nd / Full

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐
 Republic of the Philippines
Department of Education
REGION I
SCHOOLS DIVISION OFFICE I PANGASINAN
Binmaley I District
PARAYAO NATIONAL HIGH SCHOOL
SY 2021-2022

Vaccinated Dose Received (Date)

Name Reason why unvaccinated
Yes No 1st 2nd / Full

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐
 Republic of the Philippines
Department of Education
REGION I
SCHOOLS DIVISION OFFICE I PANGASINAN
Binmaley I District
PARAYAO NATIONAL HIGH SCHOOL
SY 2021-2022

Vaccinated Dose Received (Date)

Name Reason why unvaccinated
Yes No 1st 2nd / Full

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐
 Republic of the Philippines
Department of Education
REGION I
SCHOOLS DIVISION OFFICE I PANGASINAN
Binmaley I District
PARAYAO NATIONAL HIGH SCHOOL
SY 2021-2022

Vaccinated Dose Received (Date)

Name Reason why unvaccinated
Yes No 1st 2nd / Full

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

☐ ☐

TOTAL:

_________________________________

School Head