VAW Form 1

BARANGAY DATA CAPTURE FORM

MONITORING OF INCIDENCE ON VIOLENCE AGAINST WOMEN (VAW) DURING THE COVID-19 PANDEMIC
For the period: MARCH 1- 31, 2023

Region:___________________ 111
BATAA
Province:______________________________________ N
City/Municipality:_______________________________ DINALUPIHAN
GENERAL
Barangay:____________________________________ LUNA

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

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

pls.
✔=1 ✔=1 ✔=1 ✔=1 ✔=1 ✔=1 ✔=1 ✔=1 ✔=1 ✔=1 ✔=1
specify
Victim 1                        
                         
Victim 2   NONE FOR THIS MONTH              
                         
Victim 3                        
                         
TOTAL                      

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

*If "Others," please specify

Submitted by: ANGELITO A. MONTEMAYOR

Punong Barangay
VAC Form 1
BARANGAY DATA CAPTURE FORM
MONITORING OF INCIDENCE ON VIOLENCE AGAINST CHILDREN (VAC) DURING THE COVID-19 PANDEMIC
For the period: MARCH 1 -31,2023

Region:___________________ III
Province:_____________________________________ BATAA
_ N
DINALUPIHA
City/Municipality:_______________________________ N
GENERAL
Barangay:____________________________________ LUNA

GENDER TYPES OF VIOLENCE PERPETRATORS

(2) (4) (5)
AG
VAC VICTIM/S Psychological
E Immediat Other Law Others
(1) Physica Sexual / Neglec Acquaintanc Strange Local
Male Female (3) e Family Close Enforce (ex:
l Abuse Abuse Emotional t e r Official
(2a) (2b) Member Relative r Guardian)
(4a) (4b) Abuse (4d) (5c) (5d) (5e)
(5a) (5b) (5f) (5g)
(4c)
✔=1 ✔=1 ✔=1 ✔=1 ✔=1 ✔=1 ✔=1 ✔=1 ✔=1 ✔=1 ✔=1 ✔=1 pls. specify
Child 1                            
                             
Child 2           NONE   FOR   THIS       MONTH
                             
Child 3                            
                             
TOTAL                        
*Immediate Family Member/s – parents and
*If ✔, encode "1" on the applicable fields
siblings
*If "Others," please specify *Other Close Relative/s – uncles, aunts, grandparents, cousins, etc.
 Submitte
By:
d

ANGELITO A. MONTEMAYOR