Page 1

BADAC DATA CAPTURE FORM 1

INDICATOR POSITION FIRST NAME LAST NAME SEX BIRTHDATE CIVIL STATUS ADDRESS CONTACT #
Chairperson / 18 SAN ISIDRO, PASUQUIN,
ELVIRO CALDITO M 12/20/1969 M 09386107818
Punong Barangay I.N.
Vice-Chairperson /
18 SAN ISIDRO, PASUQUIN,
Peace & Order BENGIE CULANGO M 4/11/1973 M 0989580406
I.N.
Committee Chair
Members:
Chair of Women & 18 SAN ISIDRO, PASUQUIN,
EVELYN TAGAVILLA F 7/17/1978 W 09155185083
Family Committee I.N.
18 SAN ISIDRO, PASUQUIN,
BADAC is SK Chairperson MAXIMO GARAN M 10/10/1996 S 09123410804
I.N.
composed of
School Principal / 18 SAN ISIDRO, PASUQUIN,
seven (7) MA. DINA CARIAGA F 05/29/1988 M
Representative I.N.
members
18 SAN ISIDRO, PASUQUIN,
Brgy Chief Tanod BONIFACIO TAGAVILLA M 11/29/1968 M 09991606879
I.N.
NGO / CSO 18 SAN ISIDRO, PASUQUIN,
SAMUEL CALUTTUNG M 4/12/1958 M 09567485157
Representative I.N.
Faith-based Org 18 SAN ISIDRO, PASUQUIN,
ELVIRO BACLAGAN M 1/24/1972 S
Representative I.N.
Adviser:
Local PNP Chief /
Representative
Chairperson / Peace
18 SAN ISIDRO, PASUQUIN,
& Order Committee BENGIE CULANGO M 4/11/1973 M 0989580406
I.N.
BADAC Chair
Committee on Members:
Operations is 18 SAN ISIDRO, PASUQUIN,
organized Brgy Chief Tanod BONIFACIO TAGAVILLA M 11/29/1968 M 09991606879
I.N.
BADAC Auxiliary
Refer to BADAC Auxiliary Team Profile
Team
Chairperson /
18 SAN ISIDRO, PASUQUIN,
Women & Family EVELYN TAGAVILLA F 7/17/1978 W 09155185083
I.N.
Committee Chair
Members:
BADAC 18 SAN ISIDRO, PASUQUIN,
SK Chairperson MAXIMO GARAN M 10/10/1996 S 09123410804
Committee on I.N.
Advocacy is School Principal / 18 SAN ISIDRO, PASUQUIN,
MA. DINA CARIAGA F 05/29/1988 M
organized Representative I.N.
NGO / CSO 18 SAN ISIDRO, PASUQUIN,
SAMUEL CALUTTUNG M 4/12/1958 M 09567485157
Representative I.N.
 Faith-based Org 18 SAN ISIDRO, PASUQUIN,
ELVIRO BACLAGAN M 1/24/1972 S
Representative I.N.
Page 2
BADAC DATA CAPTURE FORM 1

INDICATOR POSITION FIRST NAME LAST NAME SEX BIRTH DATE CIVIL STATUS ADDRESS CONTACT #
Barangay Kgwd. BENGIE CULANGO M 4/11/1973 M 18 SAN ISIDRO PASUQUIN 0989580406
Barangay Tanod CARLITO CASTILLO M 9/22/1974 M 18 SAN ISIDRO PASUQUIN 09368137772
RAFAEL AGUADA M 1/9/1987 S 18 SAN ISIDRO PASUQUIN
BONIFACIO TAGAVILLA M 11/29/1968 M 18 SAN ISIDRO PASUQUIN 09991606879
FERNANDO TAGAVILLA M 2/1/1984 M 18 SAN ISIDRO PASUQUIN 09108215512
ROLITO TAGAVILLA M 7/9/1962 W 18 SAN ISIDRO PASUQUIN 09100749616
CARMEL GARAN M 11/30/1993 S 18 SAN ISIDRO PASUQUIN 09101672672
CARLOS GARAN M 12/8/1968 M 18 SAN ISIDRO PASUQUIN 09482919425
BADAC RONALD CALDITO M 2/13/1976 M 18 SAN ISIDRO PASUQUIN
Auxiliary Team
EDGAR APOLINAR LLAPITAN M 7/23/1967 M 18 SAN ISIDRO PASUQUIN
(BAT) is
organized EFREN SIERRA M 3/5/1988 S 18 SAN ISIDRO PASUQUIN 09101675125

Note: Use additional page if necessary. BAT shall be composed of one member per 80 residents; 25 members per 2,000 residents.
INDICATOR UNIT OF CLUSTER FIRST NAME LAST NAME SEX BIRTH DATE CIVIL STATUS ADDRESS CONTACT #

Purok Camia Jona Sierra F 1/3/1980 S 18 SAN ISIDRO, PASUQUIN

Purok Yellowbell Estrella Dancel F M 18 SAN ISIDRO, PASUQUIN
BADAC House Purok Bougainvillea Ligaya Caldito F S 18 SAN ISIDRO, PASUQUIN
Clusters are Purok Ilang Ilang Purificacion Sierra F 2/2/1962 M 18 SAN ISIDRO, PASUQUIN
organized Purok Sampaguita Maria Theresa Ramos F 10/19/1986 M 18 SAN ISIDRO, PASUQUIN
Purok Dama de Noch Gloria Leano F W 18 SAN ISIDRO, PASUQUIN
Purok Gumamela Norie Natividad F 10/16/1974 S 18 SAN ISIDRO, PASUQUIN
Note: Use additional page if necessary. Examples of Unit of Cluster are by purok, by sitio, by block, by zone, by street, etc.
CONCURRENT
INDICATOR DESIGNATION FIRST NAME LAST NAME SEX BIRTH DATE CIVIL STATUS ADDRESS CONTACT #
(if applicable)
Barangay Duty BHW Norie Natividad F 10/16/1974 S 18 SAN ISIDRO, PASUQUIN
Officers are Jona Sierra F 3/1/1980 S 18 SAN ISIDRO, PASUQUIN
designated
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
SPEAKER /
DURATION
INDICATOR ACTIVITY TITLE VENUE FACILITATOR LEAD ORGANIZER
DATE (MM/DD/YYYY) TIME FACILITATOR

Trainings Attended
by Punong
Barangay on
Strengthening
BADACs

Note: Use additional page if necessary.

DURATION SPEAKER /
INDICATOR ACTIVITY TITLE VENUE LEAD ORGANIZER
DATE (MM/DD/YYYY) TIME FACILITATOR

Trainings /
Planning Session
Attended by
Punong Barangay
on CSAR

Note: Use additional page if necessary.

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

Trainings
Conducted by
BADAC for House
Cluster Leaders

Note: Use additional page if necessary.

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

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

Trainings Attended
by Barangay Duty
Officers
Note: Use additional page if necessary.
 Page 4
BADAC DATA CAPTURE FORM 3

DURATION PRESIDING OFFICER NO. OF PARTICIPANTS

INDICATOR ACTIVITY TITLE VENUE
DATE (MM/DD/YYYY) TIME MALE FEMALE

Conduct of
BADAC
Consultative
Meetings

Note: Use additional page if necessary.

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

Conduct of
BADAC Monthly
Meetings

Note: Use additional page if necessary.

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

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

Note: Use additional page if necessary.

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

Organization/Co-
organization of
School-based IEC
Campaign
Activities
Note: Use additional page if necessary.
Page 5

Note: Use additional page if necessary.

DURATION NO. OF PARTICIPANTS

INDICATOR ACTIVITY TITLE VENUE TARGET AUDIENCE
DATE (MM/DD/YYYY) TIME MALE FEMALE

Conduct of CSO-
led IEC Campaign
Activities

Note: Use additional page if necessary.

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

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

Note: Use additional page if necessary.

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

Organization/Co-
organization of
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
BELOW 18 ABOVE 18 BELOW 18 ABOVE 18 BELOW 18 ABOVE 18 BELOW 18 ABOVE 18

Submission of Updated
Number of Residents who N/A
Surrenderred

NO. OF SURRENDERERS ENROLLED IN WELLNESS &

STATUS / CLARIE WELLNESS & RECOVERY INTERVENTIONS
INDICATOR LEVEL OF INDICATOR RECOVERY
RISK MALE FEMALE INTERVENTIONS MALE FEMALE
TOTAL TOTAL
BELOW 18 ABOVE 18 BELOW 18 ABOVE 18 BELOW 18 ABOVE 18 BELOW 18 ABOVE 18

General
Low
Interventions

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

Inpatient
Severe Treatment &
Rehab

NO. OF SURRENDERERS WHO COMPLETED WELLNESS &

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

CLANDESTINE
INDICATOR LABORATORY

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

PRESENT/ABSENT PRESENT/ABSENT PRESENT/ABSENT PRESENT/ABSENT PRESENT/ABSENT