Health Service

Accomplishment Report
SAMPLE FORMAT
Region 4-A
For the month of June 2023

Blood Training and

Station Consultation Dental Health and Wellnes BP Monitoring Vaccination Standby Drills
Donation Seminar

Baras FS 0 0
4 23 0 0 0 0 0

TOTAL 0 0 4 23 0 0 0 0 0

Breakdown:
Uniformed Personnel: 92
Non Uniformed Personnel: 0
Dependents: 0
Civilians: 0
Total: 92

Prepared by: Verified by: Noted by:

SFO1 Patrick John D Siquinia SFO1 Patrick John D Siquinia SINSP ENRICO C APO
C, EMS C, EMS Municipal Fire Marshal
 Form No 1

Special Beneficiaries
Others
Activities (SA) (SA)

0 0 92

0 0 92
 HEALTH SERVICE
Accomplishment Report
SPECIAL ACTIVITIES
Region 4-A
For the month of June 2023

Form No. 2
No. of Beneficiaries No. of Patients
No. DATE EMS Station SPECIAL ACTIVITY
UP NUP DEP CIV UP NUP DEP CIV
1 4-May-23 Baras FS BP Monitoring 23
2 11-May-23 Baras FS BP Monitoring 23
3 18-May-23 Baras FS BP Monitoring 23
4 25-May-23 Baras FS BP Monitoring 23
5
6
7
8
9
10
92 0 0 0 0 0 0 0
92 0

Prepared by: Verified by: Noted by:

SFO1 Patrick John D Siquinia SFO1 Patrick John D Siquinia SINSP ENRICO C APO
C, EMS C, EMS Municipal Fire Marshal