ULAT NG INSIDENTE

PETSA: _____________
I. PROPAYL NG NAGREREKLAMO/INIREREKLAMO
Pangalan: _______________________________________________________________________
Relasyon sa biktima: ____________________________________________________________
Pangalan ng biktima: ____________________________________________________________
Pangkat at Seksyon: _____________________________________________________________
Gurong Tagapayo: _______________________________________________________________

II. DETALYE NG INSIDENTE/REKLAMO

Isalaysay insidente kasama ang petsa ng insidente at detalyadong paglalarawan
ng insidente, kabilang ang lugar, oras, at mga taong kasangkot].
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III. EBIDENSYA
Bilang suporta sa aking ulat, may ilang ebidensya akong nais iparating:
[Maaaring isama rito ang mga larawan, kopya ng komunikasyon, o
anumang dokumento na nagpapatunay sa insidente.]
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SIGURADUHING ISAMA ANG LAHAT NG MAHAHALAGANG DETALYE AT KATOTOHANANG NAGANAP SA

INSIDENTE PARA SA MAS MALINAW AT KUMPLETONG ULAT.
 IV. EPEKTO SA AKIN BILANG MAG-AARAL/MAGULANG/TAGAPAG-ALAGA
Ang nasabing insidente ay may malalim na epekto sa akin, kasama na rito ang
[ipahayag ang epekto sa emosyon, pag-aaral, o iba pang aspeto ng buhay sa paaralan].
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V. HANGARIN AT HINIHINGING AKSYON

Dahil dito, ako ay humihiling ng mga sumusunod:
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VI. PAGTATAPOS
Ako ay umaasa na ang inilahad kong ulat ay maaaring magsilbing batayan para sa
wastong pagkilos at pagsasaayos ng sitwasyon. Inaasahan ko ang agarang pagtugon
at aksyon mula sa pamunuan ng paaralan upang mapanatili ang kaligtasan at
maayos na kapaligiran para sa lahat ng mga mag-aaral.

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Pangalan At Lagda Ng Mag-Aaral

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Pangalan At Lagda Ng
Magulang/Tagapangalaga
(Isulat din ang numero ng telepono)

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Pangalan At Lagda Ng Gurong Tagapayo
 ULAT NG INSIDENTE

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Pangalan At Lagda Ng Guro Sa Patnubay

SIGURADUHING ISAMA ANG LAHAT NG MAHAHALAGANG DETALYE AT KATOTOHANANG NAGANAP SA

INSIDENTE PARA SA MAS MALINAW AT KUMPLETONG ULAT.