Republic of the Philippines

Department of Education
Region I
SCHOOLS DIVISION OFFICE I PANGASINAN

School-Based Report on Incidents of Bullying

School Year 2022-2023
School: WARDING ELEMENTARY SCHOOL Classification (Public/Private): PUBLIC
Address: Warding, Bayambang, Pangasinan Level (Kindergarten/Elementary/Secondary):Kindergarten & Elementary

Date/Place Nature of Bullying Victims Perpetrator No. of Bullying Incidents

of Incident
Physical Social Gender- Cyber Retaliation LRN Age Sex LRN Age Sex Action Taken Recommendation Status
Based Bullying (M/F) (M/F) (Resolved/Pend
ing/Referred to
other agency)
0 0 0 0 0 0 - - - - - - - - -

Total 0 0 0 0 0 - - - - - - - - -
Note: Bullying is perpetrated by a student against another student which may be:
 Physical – unwanted physical contact (punching, shoving, pushing, kicking, slapping, tickling, headlocks, etc.)
 Social – refers to any deliberate, repetitive, and aggressive social behavior intended to hurt or belittle an individual (name-calling, cursing, labeling, etc.)
 Gender-based – refers to any act that humiliates or excludes a person on the basis of perceived or actual sexual orientation and gender identity
 Cyberbullying – any bullying done through the use of technology or any electronic means (texting, email, chatting, online games, etc.)
This form shall be used by both Public and Private schools.

Prepared by: RHEA B. BATO / Teacher IIII Reviewed and Confirmed by: GEORGE P. DELA CRUZ
Name and Designation Name and Designation
(School Child Protection Focal Person/Guidance Counselor) (Principal/School Head)

Date: Oct.9,2023 Date: Oct 9,2023