VAC Form 1

BARANGAY DATA CAPTURE FORM

MONITORING OF INCIDENCE ON VIOLENCE AGAINST CHILDREN (VAC) DURING THE COVID-19 PANDEMIC
For the period: 4th QUARTER, 2022

Region:_______ VIII
Province:_____ LEYTE
City/Municipality:____ A. TUMAMAK
Barangay:____________ VILLABA, , LEYTE

GENDER TYPES OF VIOLENCE PERPETRATORS ACTIONS TAKEN BY THE BARANGAY/BCPC

(2) (4) (5) (6)
Others
Psychologic Immediate Others Referred for Referred for (ex:
Physical Sexual al/ Other Close Acquainta Local Law Referred to Referred Referred
Male Female Neglect Family Stranger (ex: Medical Legal Referred to
VAC VICTIM/S AGE Abuse Abuse Emotional Relative nce (5d)
Official Enforcer MSWDO to PNP to NBI
(2a) (2b) Abuse (4d) Member Guardian) Treatment Assistance NGOs,
(1) (3) (4a) (4b) (5b) (5c) (5e) (5f) (6a) (6b) (6c)
(4c) (5a) (5g) (6d) (6e) FBOs)
(6f)

✔=1 ✔=1 ✔=1 ✔=1 ✔=1 ✔=1 ✔=1 ✔=1 ✔=1 ✔=1 ✔=1 ✔=1 pls. specify ✔=1 ✔=1 ✔=1 ✔=1 ✔=1 pls. specify

OCTOBER 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

NOVEMBER 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

DECEMBER 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

TOTAL 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
*If ✔, encode "1" on the applicable fields *Immediate Family Member/s – parents and siblings
*If "Others," please specify *Other Close Relative/s – uncles, aunts, grandparents, cousins, etc.

Submitted by: HON. RENATO P. TUMAMAK

Punong Barangay