Republic of the Philippines

Department of Education
Region I
SCHOOLS DIVISION OFFICE I PANGASINAN

Child Sexual Abuse and Harassment Weekly Report (template)

____________, 2023

ELY S. UBALDO, CESO VI

Assistant Schools Division Superintendent
OIC, Office of the Schools Division Superintendent

Madam:

Respectfully submitting to your good office this Report on the Incident of Sexual Abuse
and Harassment in our school.

Report on the Incident of Sexual Abuse and Harassment Case/s

School: Schools District:
Names of Parties Involved Nature of the Status of the Ways
Incident/Case Incident/Case Forward/Next Step
VICTIM/S : /Intervention
Name (Alias/LRN) : /Recommendation
Age :
Sex :
Address :
Other Info :

PERPETRATOR/S:
Name (Alias/LRN) :
Age :
Sex :
Address :
Other Info :

Thank You and God Bless!

Truly Yours,

Signature over printed name

School Head Position :

School : ______________________

1
 Republic of the Philippines
Department of Education
Region I
SCHOOLS DIVISION OFFICE I PANGASINAN

Schools District : ___________________

Contact No: __________________
DepEd Email Address: pangdeles@gmail.com