Page 1

BADAC DATA CAPTURE FORM 1

INDICATOR POSITION FIRST NAME LAST NAME SEX BIRTHDATE CIVIL STATUS ADDRESS CONTACT #
Chairperson / Zone 4, Cabaritan, San Manuel,
JOEL CUISON M 12/3/1981 M 9560611050
Punong Barangay Pangasinan
Vice-Chairperson /
Zone 1, Cabaritan, San Manuel,
Peace & Order REYNALDO CENTINO M 12/28/1961 M N/A
Pangasinan
Committee Chair
Members:
Chair of Women & Zone 2, Cabaritan, San Manuel,
HAROLD NISPEROS M 7/19/1980 S 9083267033
Family Committee Pangasinan
Zone 6, Cabaritan, San Manuel,
1. BADAC is SK Chairperson LIEVY GIE ALMOGELA F 1/26/1998 S
Pangasinan
composed of
seven (7) School Principal / Zone 4, Cabaritan, San Manuel,
MELANIE PATUBO F 8/1/1981 M N/A
members Representative Pangasinan
Zone 6, Cabaritan, San Manuel,
Brgy Chief Tanod JERRY STA CRUZ M 9/16/1969 S N/A
Pangasinan
NGO / CSO Zone 3, Cabaritan, San Manuel,
LUIS DE GUZMAN M N/A
Representative Pangasinan
Faith-based Org Zone 3, Cabaritan, San Manuel,
LOU SALVADOR M M N/A
Representative Pangasinan
Adviser:
Local PNP Chief /
EDGAR ALLAN SERQUIÑA M M SAN MANUEL PS N/A
Representative
Chairperson / Peace
Zone 1, Cabaritan, San Manuel,
& Order Committee REYNALDO CENTINO M 12/28/1961 M N/A
Pangasinan
2. BADAC Chair
Committee on Members:
Operations is Zone 6, Cabaritan, San Manuel,
organized Brgy Chief Tanod JERRY STA CRUZ M 9/16/1961 S N/A
Pangasinan
BADAC Auxiliary
Refer to BADAC Auxiliary Team Profile
Team
Chairperson /
Zone 2, Cabaritan, San Manuel,
Women & Family HAROLD NISPEROS M 7/19/1980 S 9083267033
Pangasinan
Committee
Members: Chair
3. BADAC Zone 6, Cabaritan, San Manuel,
Committee on SK Chairperson LIEVY GIE ALMOGELA F 1/26/1998 S
Pangasinan
966966514
Advocacy is School Principal / Zone 4, Cabaritan, San Manuel,
MELANIE PATUBO F 8/1/1981 M N/A
organized Representative
NGO / CSO Pangasinan
Zone 3, Cabaritan, San Manuel,
LUIS DE GUZMAN M M N/A
Representative
Faith-based Org Pangasinan
Zone 3, Cabaritan, San Manuel,
LOU SALVADOR M M N/A
Representative Pangasinan
Page 2
BADAC DATA CAPTURE FORM 1
 INDICATOR TOTAL NUMBER OF MALE TOTAL NUMBER OF FEMALE TOTAL NUMBER OF BAT MEMBER

4. BADAC
Auxiliary Team
14 1 15
(BAT) is
organized

Note: Use additional page if necessary. BAT shall be composed of one member per 80 residents; 25 members per 2,000 residents.

TOTAL NUMBER OF NUMBER OF MALE NUMBER OF FEMALE

INDICATOR UNIT OF CLUSTER TOTAL NUMBER OF HOUSE CLUSTER LEADERS
HOUSE CLUSTER CLUSTER LEADERS CLUSTER LEADERS

5. BADAC
House 7
7 140 6 1
Clusters are
organized

Note: Use additionalCONCURRENT

page if necessary. Examples of Unit of Cluster are by purok, by sitio, by block, by zone, by street, etc.
INDICATOR DESIGNATION FIRST NAME LAST NAME SEX BIRTH DATE CIVIL STATUS ADDRESS CONTACT #
(if applicable) Zone 1, Cabaritan, San Manuel,
REYNALDO PATI M M N/A
Pangasinan
Zone 4, Cabaritan, San Manuel,
6. Barangay ROMY SERVITILLIO M M N/A
Pangasinan
Duty Officers Zone 6, Cabaritan, San Manuel,
are designated LYNDON GABRIEL M M N/A
Pangasinan

Zone 7, Cabaritan, San Manuel,

JOVITA TABAYOYONG F M N/A
Pangasinan
Note: Use additional page if necessary. Concurrent Designation refers to the primary appointment / item of the designated Brgy Duty Officer in the barangay, e.g. Barangay
Health Worker, VAWC Desk Officer, etc.
 Page 3
BADAC DATA CAPTURE FORM 2
DURATION SPEAKER /
INDICATOR ACTIVITY TITLE VENUE LEAD ORGANIZER
DATE (MM/DD/YYYY) TIME FACILITATOR
8. Trainings
Attended by PB on
Strengthening
BADACs
Note: Use additional page if necessary.
DURATION SPEAKER /
INDICATOR ACTIVITY TITLE VENUE LEAD ORGANIZER
DATE (MM/DD/YYYY) TIME FACILITATOR

9. Trainings /
Planning Session
Attended by
Punong Barangay
on CSAR

Note: Use additional page if necessary.

DURATION NO. OF
SPEAKER / PARTICIPANTS
INDICATOR ACTIVITY TITLE VENUE
FACILITATOR
DATE (MM/DD/YYYY) TIME MALE FEMALE
10. Trainings
Conducted by
BADAC for House
Cluster Leaders
Note: Use additional page if necessary.
DURATION NO. OF
SPEAKER / PARTICIPANTS
INDICATOR ACTIVITY TITLE VENUE
FACILITATOR
DATE (MM/DD/YYYY) TIME MALE FEMALE

11. Trainings
Conducted by
BADAC for BADAC
Auxiliary Team

Note: Use additional page if necessary.

DURATION SPEAKER /
INDICATOR ACTIVITY TITLE VENUE LEAD ORGANIZER
DATE (MM/DD/YYYY) TIME FACILITATOR
12. Trainings
Attended by
Barangay Duty
Officers
Note: Use additional page if necessary.
 Page 4
BADAC DATA CAPTURE FORM 3

DURATION NO. OF
INDICATOR ACTIVITY TITLE VENUE PRESIDING OFFICER PARTICIPANTS
DATE (MM/DD/YYYY) TIME MALE FEMALE
13. Conduct of BADAC
Consultative Meetings
with Stakeholders
Note: Use additional page if necessary.
DURATION NO. OF
INDICATOR ACTIVITY TITLE VENUE PRESIDING OFFICER PARTICIPANTS
DATE (MM/DD/YYYY) TIME MALE FEMALE

14. Conduct of BADAC

Monthly Meetings

Note: Use additional page if necessary.

DURATION NO. OF
INDICATOR ACTIVITY TITLE VENUE TARGET AUDIENCE PARTICIPANTS
DATE (MM/DD/YYYY) TIME MALE FEMALE

15. Organization/Co-
organization of
Community-based IEC
Campaign Activities

Note: Use additional page if necessary.

DURATION NO. OF
INDICATOR ACTIVITY TITLE VENUE TARGET AUDIENCE PARTICIPANTS
DATE (MM/DD/YYYY) TIME MALE FEMALE

16. Organization/Co-
organization of School-
based IEC Campaign
Activities
Note: Use additional page if necessary.
Page 5
BADAC DATA CAPTURE FORM 3

DURATION NO. OF
INDICATOR ACTIVITY TITLE VENUE TARGET AUDIENCE PARTICIPANTS
DATE (MM/DD/YYYY) TIME MALE FEMALE

17. Conduct of Youth-

led IEC Campaign
Activities

Note: Use additional page if necessary.

DURATION NO. OF
INDICATOR ACTIVITY TITLE VENUE TARGET AUDIENCE PARTICIPANTS
DATE (MM/DD/YYYY) TIME MALE FEMALE

18. Conduct of CSO-led

IEC Campaign
Activities

Note: Use additional page if necessary.

DURATION NO. OF
INDICATOR ACTIVITY TITLE VENUE TARGET AUDIENCE PARTICIPANTS
DATE (MM/DD/YYYY) TIME MALE FEMALE

19. Organization/Co-
organization of
Activities in
Observance of the
IDADAIT

Note: Use additional page if necessary.

DURATION NO. OF
INDICATOR ACTIVITY TITLE VENUE TARGET AUDIENCE PARTICIPANTS
DATE (MM/DD/YYYY) TIME MALE FEMALE

20. Organization/Co-
organization of
Activities in
Observance of the
DAPC Week
 Activities in
Observance of the
DAPC Week

Note: Use additional page if necessary.

 Page 6
BADAC DATA CAPTURE FORM 4
UNIFIED BARANGAY REPORT ON REFERRAL ACTION (UBRRA)

Data provided herein are those recorded within the months of: January to June ( ) July to December ( ) Year (YYYY): __________________________

NO. OF SURRENDERERS NO. OF REFERRED SURRENDERERS

INDICATOR INDICATOR
MALE FEMALE MALE FEMALE
TOTAL TOTAL
17 & BELOW 18 & ABOVE 17 & BELOW 18 & ABOVE 17 & BELOW 18 & ABOVE 17 & BELOW 18 & ABOVE

21. Submission of Updated 22. Submission of Updated

Number of Residents who Number of Referred
Surrenderred Surrenderers

NO. OF SURRENDERERS ENROLLED IN WELLNESS &

STATUS / STATUS AND NO. OF ASSESSED SURRENDERERS WELLNESS & RECOVERY INTERVENTIONS
INDICATOR LEVEL OF INDICATOR RECOVERY
RISK MALE FEMALE INTERVENTIONS MALE FEMALE
TOTAL TOTAL
17 & BELOW 18 & ABOVE 17 & BELOW 18 & ABOVE 17 & BELOW 18 & ABOVE 17 & BELOW 18 & ABOVE

General
Low
Interventions

Community-based
Mild 23.B Treatment &
23.A Submission
Submission of Rehab
of Updated
Updated
Number of
Number of Health Facility-
Assessed
Enrolled based Outpatient
Surrenderers Moderate Surrenderers Treatment &
Rehab

Inpatient
Severe Treatment &
Rehab

NO. OF SURRENDERERS WHO COMPLETED WELLNESS &

RECOVERY INTERVENTIONS
INDICATOR The purpose of this form is to determine the number of surrenderers per semester (January-June,
MALE FEMALE
TOTAL July-December), and monitor the number of who, among those surrenderers, have been referred,
17 & BELOW 18 & ABOVE 17 & BELOW 18 & ABOVE assessed, and who have completed any Wellness and Recovery Program interventions within the
6-month time frame. Counting shall restart at the onset of the new semester; meaning, the data on
24. Submission of Updated
those who surrendered in the previous semester shall no longer be accounted in the next,
Number of Surrenderers Who
regardless of whether they have been referred or assessed in the following semester.
Completed Wellness &
Recovery Interventions
Number of Surrenderers Who
regardless of whether they have been referred or assessed in the following semester.
Completed Wellness &
Recovery Interventions
 Page 7
BADAC DATA CAPTURE FORM 5
COMMUNITY SUPPORT, AFTERCARE AND REINTEGRATION (CSAR)

Data provided herein are those recorded within the months of: January to June ( ) July to December ( ) Year (YYYY): ________________________

NO. OF CSAR ENROLLEES NO. OF CSAR GRADUATES

INDICATOR INDICATOR
MALE FEMALE MALE FEMALE
TOTAL TOTAL
17 & BELOW 18 & ABOVE 17 & BELOW 18 & ABOVE 17 & BELOW 18 & ABOVE 17 & BELOW 18 & ABOVE

26. Submission of
25. Submission of Updated Updated Number of
Number of Residents Residents Who
Enrolled in CSAR Program, Completed the
or its equivalent CSAR Program, or
its equivalent

The purpose of this form is to determine the number of residents enrolled in CSAR Program, or its equivalent, per semester (January-June, July-December), and monitor the number of who,
among those enrolled, have completed the CSAR program within the 6-month time frame. Counting shall restart at the onset of the new semester; meaning, the data on those enrolled in the
previous semester shall no longer be accounted in the next, regardless of whether they have been referred or assessed in the following semester.
 Page 8
BADAC DATA CAPTURE FORM 6
SUMMARY OF CONSOLIDATED INFORMATION REPORT
as per Section 8 of DDB Board Regulation No. 3, s. 2017
Year (YYYY): _________

Data provided herein are those recorded within the months of: January to March ( ) April to June ( ) July to September ( ) October to December ( )

DRUG TRANSIT /
DRUG PUSHER DRUG USER / DEPENDENT DRUG SUPPLY AVAILABILITY CLANDESTINE LABORATORY
TRANSHIPMENT ACTIVITY
INDICATOR

PRESENT / PRESENT /
TOTAL TOTAL PRESENT / ABSENT PRESENT / ABSENT PRESENT / ABSENT TOTAL
ABSENT ABSENT

27.
Submission CLANDESTINE DRUG CLANDESTINE CHEMICAL MARIJUANA CULTIVATION DRUG PROTECTOR / CODDLER
of Updated DRUG DEN, DIVE OR RESORT
WAREHOUSE WAREHOUSE SITE / PLANTATION & FINANCIER
Summary of
Consodated
Information
Report (CIR)
PRESENT / PRESENT / PRESENT / PRESENT PRESENT /
TOTAL TOTAL TOTAL TOTAL TOTAL
ABSENT ABSENT ABSENT / ABSENT ABSENT