Republic of the Philippines

Department of Education
REGION IV-A - CALABARZON
SCHOOLS DIVISION OF RIZAL
<School Name>

SCHOOL SAFETY PLAN

School Name : <School Name>

Contact Number : <Contact Number>
School ID : <School ID>
SBM Level of Practice : <SBM Level of Practice>
School Head : <Name of School Head>
Contact Number : <Contact Number>

I. Introduction

II. School Profile

<brief description of School location>
<identified common hazards and risks involving learners and
personnel>

A. Baseline Data

1) Number of Learners
Categories Grade Level Male Female
Kinder
1
Number of Learners 2
(excluding Muslims, 3
IPs, learners with 4
disability) 5
6
7
Number of Muslim Kinder
Learners 1
2

Address: DepEd Bldg. Cabrera Road Brgy. Dolores, Taytay, Rizal

Trunkline: 85395140 to 42
Email Address: rizal@deped.gov.ph
Website: depedrizal.ph
 Page 2 of 6

3
4
5
6
7
Kinder
1
2
Number of IP 3
Learners 4
5
6
7
Kinder
1
2
Number of Learners 3
with Disability 4
5
6
7
TOTAL

2) Number of School Personnel

Categories Male Female
Number of Teaching Personnel (TP)
(excluding Muslims, IPs, personnel with disability)
Number of Muslim TP
Number of IP TP
Number of TP with Disability
Number of Non-Teaching Personnel (NTP)
(excluding Muslims, IPs, personnel with disability)
Number of Muslim NTP
Number of IP NTP
Number of NTP with Disability
TOTAL

III. Situation
Action Taken / Current
No. Identified Incident Brief Summary
Control and Intervention
1
2
3
4
5
Address: <School Address>
School ID:
<School logo>
Contact Number:
Email Address:
 Page 3 of 6

IV. School Safety Committee

<Incident No.>

<Name>
<Contact Number>
<Position/Designation>
Lead

<Name>
<Contact Number>
<Position/Designation>
Alternate

<Name> <Name>
<Contact Number> <Contact Number>
<Position/Designation> <Position/Designation>
Internal Member External Member

V. School Safety Plan

Step-by-Step Recovery/ Resources Person
Hazard Risk Incident Prevention
Response Reintegration Needed In-Charge

VI. Resource Projection, Capacity, and Needs

Current Resources Needed Resources
No. Incident
(trained personnel, facility, materials) (trained personnel, facility, materials)
1
2
3
4
5

Address: <School Address>

School ID:
<School logo>
Contact Number:
Email Address:
 Page 4 of 6

VII. Communication Plan

A. Communication Directory
No. Internal/External Role Player Contact Details Office/Address
<Name> <mobile number>
(Internal/External) <e-mail address>
1
2
3
4
5
6
7
8

B. Communication Protocol

<Incident No.>

Step 1 Step 2 Step 3 Step 4 Step …

VIII. Monitoring and Evaluation

Address: <School Address>

School ID:
<School logo>
Contact Number:
Email Address:
 Page 5 of 6

Intermediate Outcome 1

Intermediate Outcomes
Intermediate Outcome 2
Enabling Mechanisms

Sector Outcome

Goal
Intermediate Outcome 3

IX. Appendix

A. School Hazard Map

B. Memorandum of Agreement

Address: <School Address>

School ID:
<School logo>
Contact Number:
Email Address:
 Page 6 of 6

Prepared by:

<NAME>
School Safety Plan Committee

Recommending Approval: Approved:

<NAME> <NAME>
School Head Public School District Supervisor

Conformed:

<NAME>
<Internal and External Partner and Role Player>

Address: <School Address>

School ID:
<School logo>
Contact Number:
Email Address: