Child Protection Intake Sheet and Enclosures
September 12, 2022 | Author: Anonymous | Category: N/A
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Enclosure A-1 Annex “B” “B” Department of Education INTAKE SHEET I. INFORMATION: A. VICTIM: Name: ____________ _______________________ _______________________ ______________________ __________ Date of Birth: __________________________ __________________________ Age: __________ Sex: ___________ Gr. /Yr. and Section: __________________ __________________
Adviser: ____________ ____________
Parents: Mother: ______________________ _______________________ _
Age: _______
Occupation: ____________________ ____________________ Address: ______________________ _______________________ _ Father: _______________________ ________________________ _
Age: _______
Occupation: ____________________ ____________________ Address and Contact Number: _______________________ ___________________________________ _______________________ _______________ ____
____________________________________ _________________________ ______________________ ______________________ ______________________ _________________ ______ ___________________________________________________________________________
B. COMPLAINANT: Name: _____________ ________________________ _______________________ ________________________ ________________ ____ Relationship to Victim: ______________________ _________________________________ _____________ __ Address and Contact Number: _______________________ ___________________________________ ______________________ ______________________ ____________ ______________________ _____________ ______________________ ______________________ ______________________ _______________________ ______________________ _______________ ___ ______________________ _____________ ______________________ ______________________ ______________________ _______________________ ______________________ _______________ ___ C. RESPONDENT: C-1. If respondent is a School Personnel Name: ____________ _______________________ _________________________ _________________________ ________________ _____ Date of o f Birth: _______________________ ___________________________ ____ Age: ________________ ________________ Sex: ________________ ________________
Designation/Position: ____________ _______________________ ______________________ ___________ Address and Contact Number: ______________________ _________________________________ _______________________ _________________ _____ ______________________ _____________ ______________________ ______________________ ______________________ ______________________ __________________ _________
___________________________________________________________________________
C-2. If respondent is a Student Name: ____________ _______________________ _______________________ _______________________ _____________ __ Date of Birth: __________________________ __________________________ Age: _____________ Sex: ___________ _____________ __ Gr. /Yr. and Section: ____________________ ____________________
Adviser: ______________ ______________
Parents/Guardian: Mother: ______________________ ______________________________ ________
Age: __________
Occupation: ______________________ ______________________ Address and Contact Number: ________________________________ _________________________________________ __________________ _________
____________________________________ _________________________ ______________________ ______________________ ______________________ _________________ ______ ___________________________________________________________________________ Father: _______________________ ______________________________ _______
Age: __________
Occupation: _______________________ ___________________________ ____ Address and Contact Number: ______________________ _________________________________ _______________________ _________________ _____
____________________________________ _________________________ ______________________ ______________________ ______________________ _________________ ______ ___________________________________________________________________________
II. DETAILS OF THE CASE: ___________________________________ ______________________ ______________________ ______________________ _______________________ ______________________ _______________ ___ ______________________ _____________ ______________________ ______________________ ______________________ _______________________ ______________________ _______________ ___ ______________________ _____________ _________________________ ___________________________ _______________________ _______________________ _____________________ __________ ______________________ _____________ ______________________ ______________________ ______________________ _______________________ ______________________ _______________ ___ ______________________ _____________ ______________________ ______________________ ______________________ _______________________ ______________________ _______________ ___ ______________________ _____________ ______________________ __________________________ _________________________ ______________________ ______________________ ____________
III. ACTION TAKEN: 1. 2. 3. 4.
IV. RECOMMENDATIONS: 1. 2. 3.
Prepared By: _____________________________ ______________________ _______ Name over Printed Name _____________________________ ______________________ _______ Designation _____________________________ ______________________ _______ Date
Enclosure A-2 Appendix A
Profiling and Initial Risk Assessment Tools for Children-at-Risk Children-at-Risk PART I: This form will help the guidance teacher or guidance counselor quickly note down risk factors that make the child vulnerable to coming into conflict with the law. A check mark on those items in red/bold font require immediate referral of the child to the LSWDO, DSWD or licensed child-caring agencies and NGOs for further assessment and treatment or intervention planning. A mark on the other items or factors, other than those in red, require further investigation or data gathering on the part of the school CPC before referral is made to the LSWDO L SWDO or DSWD. Initial assessment made using this form will not substitute for the professional assessment and judgment of a licensed counselor, licensed child psychologist and licensed social worker.
I. Child’s Identifying Information Information
Name: _____________ _________________________ ________________________ _______________________ _______________________ _________________________ ________________ ___ Age: ________________ ________________
Date of Birth: _______________________ ________________________ _
Sex: ________________ ________________ Address: ________________________ ___________________________________ ______________________ ______________________ ______________________ _________________ ______ In School?
Caregivers:
____ Yes;
Grade/Year Level: ____________ ____________
____ No;
Highest grade/year level finished: ________________ _________________ _
____ Father only
____ Mother only
____ Father and Mother
____ Others(indicate relationship to child): ______________ _________________________ ___________________ ________ Caregiver’s source of o f income/employment and monthly income: _____________________________ _____________________________ No. of Siblings: _________ Ordinal Position: ___________
No. of Siblings below 18 yrs. Old: _______________ _______________
Appendix A II. Individual factors:
_____ History of substance/Alcohol abuse _____ Involvement in gangs _____ Involvement in any positive youth development development activity, identify: _______________________ _______________________ _____ Reported incidents of sudden outbursts of anger/irritability exhibited in school school _____ Report or allegations of traumatic experience experience of the child _____ Reported recent suicide suicide attempts or suicidal ideation _____ Child observed in class class to be depressed, anxious anxious and out of focus most of the time _____ Constant somatic complaints complaints _____ Reported/Noted thoughts thoughts disturbances
Types of offenses committed (Mark with X and indicate how many times reported for every type of offense committed) _______________ _____________ __ Theft _______________ _____________ __ Robbery _______________ _____________ __ Physical injuries _______________ _____________ __ Sexual harassment _______________ _____________ __ Rape _______________ _____________ __ Homicide _______________ _____________ __ Murder _______________ _____________ __ Drug-related offense _______________ _____________ __ Other offenses punished under under penal laws (please indicate)
Family/community factors: _____ Child is a victim of abuse, abuse, identity ________________ ________________ (sexual, physical, e emotional, motional, verbal) _____ Child is a victim of neglect neglect _____ Child has no parents parents or no adult guardian in the household household _____ History of parental criminal behavior behavior _____ History of sibling’s criminal sibling’s criminal behavior _____ Witness to family/domestic violence violence _____ Parent substance abuse abuse _____ Homeless _____ Abandoned _____ Witness to community community violence
_____ Presence of support system (family, community, church, school)
School behavior _____ Child is behaving well well in school _____ Child is a victim of bullying bullying in school _____ Child has been observed to have moderate behavior problems in school _____ Child had severe severe problems with behavior in school. school. Child has been reported for bullying in school.
Juvenile Justice (JJ) History of criminal behavior _____ Current criminal behavior behavior is the first known occurrence _____ Youth has engaged in in multiple delinquent acts in the pas pastt year
Seriousness _____ Youth has engaged only in status violations or violations of local ordinances _____ Youth has engaged in in criminal behavior _____ Youth has engaged in in criminal behavior that places other citizens at ris risk k of significant physical harm
Peer Influences _____ Youth’s primary peer peer social network does not engage engage in delinquent behavior behavior _____ Youth predominantly has peers who engage in delinquent delinquent behavior _____ Youth’s primary peer peer social network are network are known to engage in criminal behavior _________________________ _____________ ____________________ ________ Indicators were based on the Juvenile Justice Module of the Child and Adolescent Needs and Manual. Preda Foundation (1999)
Strengths
Appendix A
PART II: The table below further provides a non-exhaustive list of examples of evidence which would suggest that a student has met the threshold for an immediate referral to the proper authorities (LSWDO, Licensed SW of accredited and duly-licensed child caring agency, or to the DSWD CIU) or whether there is still a need for further investigation or data gathering on the allegations before referrals are made.
Initial assessment made using this form will not substitute for the professional assessment and judgmentt of a licensed judgmen licensed counselor, counselor, licensed licensed child child psychologist psychologist and licensed licensed social social worker. worker.
Referral to LSWDO for immediate intervention within 8 hours Initial Assessment: For further investigation before referral to LSWDO or DSWD within 24 hours
Any allegation of abuse or neglect or any suspicious injury in a non-mobile child
Allegation of physical assault with no visible injury (child is mobile and verbal)
Two or more minor injuries in non-verbal young children (including disabled children)
Allegations or suspicions about a serious injury
Any incident/injury triggering concern e.g. a series of apparently accidental injuries or a minor non-accidental injury
Allegations or suspicions about a sexual abuse perpetrated against a child
Repeated allegations or reasonable suspicions of non-accidental injury or injuries
The child has been traumatized, injured or neglected as a result of domestic violence Repeated allegations involving serious verbal threats and/or emotional abuse
Repeated expressed minor concerns from one or more sources on suspicions on non-accidental injury
Allegation concerning verbal threats
Allegations of emotional abuse including that caused by minor domestic violence
Appendix A Allegations/reasonable suspicions of serious neglect
Direct allegation of sexual abuse made by child or abuser’s confession to such abuse Any allegation suggesting connections between sexually abused children in different families or more than one abuser.
Allegations of periodic neglect including insufficient supervision; poor hygiene; clothing or nutrition; failure to seek/attend treatments or appointments; young carers undertaking intimate personal care.
Suspicions of sexual abuse (e.g. medical concerns, sexualized behavior, or referral by concerned relative, neighbor and caregiver)
An individual inside the child’s home
posing a risk to the child (alleged perpetrator living with the child or who has daily access to the child/adult alleged of threatening child to commit crime, etc.)
Any suspicious injury or allegation involving a child already subject to a child protection plan or looked after by a local authority. No Available parent/carer and child is left abandoned child
Suspicion that a child has suffered or is at risk of significant harm due to fabricated/induced illness.
A child reported to be at-risk of sexual exploitation of trafficking
Pregnancy in a child
No available parent, child in need of temporary accommodation and no specific risk if this needs is met
Appendix A
A child at risk of forced marriage
Initial assessment made by: ___________________________________ ______________________ ______________ _ Name and Signature
______________________ _________________________ ___ Designation
Noted By: ___________________________________ ______________________ ______________ _ Name and Signature
______________________ _________________________ ___ Designation
Enclosure A-3 Appendix B
Children in Conflict with the Law (CICL) Intake Form
Division: __________________ __________________ Region: __________________ __________________ Name of School: ________________________ __________________________________ ______________________ _______________________ ___________ Address: _____________________ ________________________________ ______________________ ______________________ ____________________ _________ Case. No: _____________________ _____________________ Date: _____________________ ________________________ ___
I. Identifying Information Name: __________ _______________________ ________________________ ______________________ _________________________ ________________ __ Nickname: __________________ __________________ Age: ___________ ___________ Sex: _________________ _________________ Date of Birth: _____________________ Place of Birth: _____________________ _____________________ Address: _____________________ _________ _______________________ ______________________ __________________________ _________________ __ Grade/Year Level & Section: ________________________ ____________ _______________________ ____________________ _________ Class Adviser: _______________________ ________________________________ ______________________ ______________________ ___________ __
Parents/Guardian Information: Parents/Guardian: ______________________ ________________________________ ______________________ ____________________ ________ Address: _____________________ ________________________________ ______________________ ______________________ _________________ ______ Contact No’s No’s:: ________________________________________________________
II. Problem Presented (Information on the Reported Offense) Alleged offense committed by the student (describe incident as reported): ___________________________________ ______________________ ______________________ ______________________ _______________________ ______________________ _______________ ___ ______________________ _____________ ______________________ ______________________ ______________________ _______________________ ______________________ _______________ ___ _______________________ _____________ ______________________ _______________________ ______________________ _______________________ _______________________ _____________ __ ______________________ _____________ ______________________ ______________________ ______________________ _______________________ ______________________ _______________ ___ Place and Date D ate of Alleged A lleged Commission of Offense: Of fense: _____________ ________________________ ______________________ _________________ ______ Name of referring party/relation to the child: ____________________ _____________________________ ______________________ _______________ __ Name of victim/s (if any): ______________________________ _________________________________ ___ Grade/Level: ________________ Previous Offense reported in school, if any (please indicate date): _______________________ _____________ ______________________ ________________________ _______________________ ______________________ ______________________ _____________ __
Appendix B
III. Actions Taken, if any ______________________ _____________ ______________________ ______________________ ______________________ _______________________ ______________________ _______________ ___ ______________________ _____________ ______________________ ______________________ ______________________ _______________________ ______________________ _______________ ___ ______________________ _____________ ______________________ ______________________ ______________________ _______________________ ______________________ _______________ ___ _______________________ _____________ ______________________ ______________________ ______________________ ______________________ ______________________ _______________ ___
IV. Disposition: Referred and/or Released to: LSWDO Name: _________ ______________________ __________________ _____ Contact No: ___________________ ___________________ PNP Name: _________________________ ______________________________ _____ Contact No: ___________________ ___________________ NGO/FBO Name of Organization: __________________________________ _____________________________________________ ______________ ___ Contact No: ___________________ ___________________
Released to: Parents Guardian Relative/s Name: _______________________ ________________________________ _________ Contact No: __________________
__________________________________ ______________________ ______________ __ Name and Signature of Receiving Copy Address: _____________________ ________________________________ ______________________ ________________ _____
Prepared by:
________________________________ ______________________ __________ Name and Signature
______________________ _________________________ ___ Designation
Noted by:
________________________________ ______________________ __________ Name and Signature
______________________ _________________________ ___ Designation
Enclosure A-4 Appendix C
REFERRAL FOR SERVICE
Instructions
This form should be completed by fully trained and designated staff of the school. Original copy shall be maintained in the school and shall form part of the client’s confidential records. records. Any information contained herein and the rest of the records of the client shall be held in strict confidence. No information from this card ca rd shall be shared to anyone except to service provider and as may be authorized. Attach additional pages with continued narrative, if needed.
Case No: _________________ _________________ To: ______________________ _________________________________ _______________________ ________________________ _______________________ ______________________ ___________ Address: _____________________ ________________________________ ______________________ ______________________ ______________________ ____________________ _________ Contact Person: ________________________ __________________________________ ______________________ ______________________ ______________________ ____________ Name of Student: _______________________ _________________________________ ______________________ _______________________ ______________________ ___________ Age: __________
Sex: _________
Address: ______________________ _________________________________ _____________ __
Reason/s for Referral: ______________________ _____________ ______________________ ______________________ ______________________ _______________________ _________________________ _______________ ______________________ _____________ ______________________ ______________________ ______________________ _______________________ ______________________ _______________ ___ ______________________ _____________ ______________________ ______________________ ______________________ _______________________ ______________________ _______________ ___ ______________________ _____________ ______________________ ______________________ ______________________ _______________________ ______________________ _______________ ___ ______________________ _____________ ______________________ ______________________ ______________________ _______________________ ______________________ _______________ ___ Specific Service/s Requested: ______________________ _____________ ______________________ ______________________ ______________________ _______________________ ______________________ _______________ ___ ______________________ _____________ ______________________ ______________________ ______________________ ___________________________ _________________________ ___________ ______________________ _____________ ______________________ ______________________ ______________________ _______________________ ______________________ _______________ ___ ___________________________________ ______________________ ______________________ ______________________ _______________________ ______________________ _______________ ___ ______________________ _____________ ______________________ ______________________ ______________________ _______________________ _________________________ _______________ ______________________ _____________ ______________________ ______________________ ______________________ _______________________ ______________________ _______________ ___ Please refer to attached report/ intake form /case summary for more information.
Appendix C Feedback is requested. Please send to: Referring Party/School: ____________________ _______________________________ ______________________ _______________________ ____________________ ________ Address: _____________________ ________________________________ ______________________ ______________________ ______________________ ____________________ _________ Cellphone No: ____________________ ____________________ Landline No: _____________________ ________________________________ ___________ E-mail Address: _______________________ ______________________________ _______ Fax No: ______________________ _____________________________ _______ Contact Person: ________________________ __________________________________ ______________________ ______________________ ______________________ ____________
Referred by:
___________________________________ ______________________ ______________ _ Signature over Printed Name
___________________________________ ______________________ ______________ _ Date Accomplished
______________________ ______________________________ ________ Designation
Enclosure A-5 Appendix E
RESTORATIVE JUSTICE AGREEMENT FORM I. Background of the Incident I ncident II. Statement of Agreement For the best interest of (name of offender) and the school/community, the following shall be undertaken:
For the student-offender: (Example: make a research work on the ill-effects of smoking) ___________________________________ ______________________ ______________________ ______________________ _______________________ _________________________ _______________ ______________________ _____________ ______________________ ______________________ ______________________ _______________________ ______________________ _______________ ___
For the parents of the student-offender:
______________________ _____________ ______________________ ______________________ ______________________ _______________________ ______________________ _______________ ___ _____________ ______________________ ______________________ __________________________ _________________________ ______________________ ______________________ ____________
For the teacher-adviser/Guidance Counselor or Guidance Teacher: ___________________________________ ______________________ ______________________ ______________________ _______________________ ______________________ _______________ ___ ______________________ _____________ ______________________ ______________________ ______________________ ____________________________ _________________________ __________
For the social worker or Local Social Welfare and Development Officer (LSWDO): ___________________________________ ______________________ ______________________ ______________________ _______________________ ______________________ _______________ ___ ______________________ _____________ ______________________ ______________________ ______________________ _______________________ ______________________ _______________ ___
For the victim and his/her parent/s (when appropriated): ______________________ _____________ ______________________ ______________________ ______________________ _______________________ ______________________ _______________ ___ This agreement will wil l be implemented starting _________________ until ___________________. ___________________.
Prepared by:
___________________________________ ______________________ _______________ __ Guidance Counselor/RJP Secretary
Conformed:
_________________________ ______________________ ___ ______________________ ________________________ __ (Student-offender) (Parent)
Noted by:
________________________________ ______________________ __________ Principal/RJP Chairperson
______________________ ____________________________ ______ LSWDO/Social Worker
Enclosure A-6 School-Based Report on Incidents of Bullying School Year: _________ ________________ _______ School: _______________ ___________________ _____ Address: __________________ ___________________
Classification: (Private/Public) ________________ __________________ Level: (Kindergarten/Elementary, Secondary) ________________ ______
Nature of Bullying Date/Place of Incident
Physical
Social
GenderBased
Cyber Bullying
Victims Retaliation
Name
Age
Perpetrator Sex (M/F)
Name
Age
Sex (M/F)
Action taken
Recommendation
Status (Resolved/Pending/ Referred to other agency)
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, labelling, etc.) Gender-based – Gender-based – refers refers to any act that humiliates or excludes a person on the basis of perceived or actual sexual orientation and gender identity. Cyber Bullying – Bullying – any any bullying done through the use of technology or any electronic means (texting, email, chatting, online games, etc.)
Reviewed and Conformed by:
_________________ ____________ Name and Designation Date:
Prepared by:
_________________ _____
_________________ ____________ Name/Designation Date:
_______________ ___________
Enclosure A-7 School-Based Report on Incidents of Child Abuse School Year: ________ _____________ _____ School: _______________ ____________________ ____
Classification: (Private/Public) ________________ ___________
Address: __________________ ____________________
Level: (Kindergarten/Elementary, Secondary) _______________
Date of Incident
Nature of Abuse Verbal/ Physical Sexual Psychologic al
Victims Name (Last Name, Age First Name, M.I)
Sex (M/F)
Perpetrators Name (Last Name, Age First Name, M.I)
Sex (M/F)
Relationship to the Victim
Action Taken
Status (Resolved/Pending/R eferred to other agency)
TOTAL Note: Child Abuse refers to the maltreatment of a child, whether habitual or n ot, which includes any of the following: Physical-refers to acts that inflict bodily harm and w hich subjects children to perform tasks which are hazardous to their physical well-being; Sexual-refers to acts that are sexual in nature such as rape, sexual harassment, sexually demeaning remarks, forcing children to watch obscene publications or shows, etc.; and
Psychological – – refers refers to acts o r omissions causing or likely to cause menta l or emotional suffering to the child which include intimidation, harassment, stalking, Psychological
public ridicule, threat of deduction from grade or merit as a form of punishment, and repeated verbal abuse. - -
Relationship to the victim refers to relatives (fathe r, mother, cousin, etc.) or school personnel (tea chers and non-teaching staff) No amicable settlement for any acts of child abuse
Reviewed and Conformed by:
_________________ __________________ Name and Designation
Date: ___________________ ___________
Prepared by:
_________________ ___________________ _ Name/Designation
Date: ___________________ _____________
Enclosure A-8 Appendix D
CONSOLIDATED REPORT ON CASES OF CHILDREN-AT-RISK (CAR) School/Division/Region: _______________________ _________________________________ __________ Period Covered: ______________________ _________________________________ ___________
I. CHILDREN-AT-RISK (CAR) Classification
No. of Students Male Female
Action Taken
Remarks
1. Victim of Abuse (sexual, physical, psychological, mental, economic, and other mean) 2. Victim of Neglect 3. Coming from a dysfunctional family or without parent or guardian 4. Being member of a gang 5. Living in a community with a higher level of criminality 6. Living in a situation of armed conflict 7. Committed a status Offense under Section 57 of RA 9344, as amended 8. Prostituted Children 9. Mendicant under PD 1563 10. Solvent/Rugby User 11. Others
II. Description of action taken by the school or division to alleviate the risk factors of the CAR: ___________________________________ ______________________ ______________________ ______________________ _______________________ ______________________ _______________ ___ ______________________ _____________ ______________________ ______________________ ______________________ ____________________________ _________________________ __________ ______________________ _____________ ______________________ ______________________ ______________________ _______________________ ______________________ _______________ ___ ______________________ _____________ ______________________ ______________________ ______________________ _______________________ ______________________ _______________ ___ ______________________ _____________ ______________________ ______________________ ______________________ _______________________ _________________________ _______________ ______________________ _____________ ______________________ ______________________ ______________________ _______________________ ______________________ _______________ ___
Prepared by:
Noted by:
______________________ _____________ ___________ __
______________________ __________________________________ ______________ __
Designation
Principal/Superintendent/Regional Director
Enclosure A-9 Appendix F School/Division/Region: __________________________________ Period Covered: ________________________________________
A. Consolidated Report on incidents of Children in Conflict with the Law (CICL) Learner’s Sex Case/Violation Action Taken Reference Number Age (M/F) (LRN)
Intervention/Diversion Program
Remarks
B. Description of any intervention program or diversion program that the school or division initiated or adapted which facilitated the reintegration of the CICL in the school and community _______________ ___________________ ___________________ ___________________ ___________________ _____________________ _____________ __ _______________ ___________________ ___________________ ___________________ ______________ _________________ ___________________ _____ _______________ ___________________ ___________________ ___________________ ___________________ _____________________ _____________ __
Prepared by:
Noted by:
_______________ ___________________ _____ Designation
_________________ ___________________ ___ Principal/Superintendent/Regional Director
Enclosure A-10 SCHOOL-BASED CHILD PROTECTION/ANTI-BULLYING POLICY IMPLEMENTATION CHECKLIST (Based on Annex 2B of DepEd Order No. 44, s.2015: Guidelines on the Enhanced School Improvement Planning (SIP) Process and the School Report Card (SRC))
Name of School: _________________________________________ Address: ____________ ________________________ _______________________ ______________________ ____________ _ Schools District: _________________________________________ _______________________ _______________________ __________________ _______ Schools Division: ___________ __________________________________ _______________ ___ Date of Submission: ______________________ Instruction: This checklist is designed to monitor and evaluate the compliance of the school in the implementation of DepEd Order No. 40, s. 2012 and DepEd Order No. 55, s. 2013 Tick the appropriate box that corresponds to your observation P – Present – Present or In Place A – Absent – Absent or Not In Place Findings will be based simply on the presence or absence of the requirement as stated in each item and shall be the basis for a plan of action by the school and the Schools Division Office. P 1. The school has a written school-based child protection and/or anti-bullying policies 2. There is a code of conduct incorporated in the school-based child protection or anti-bullying policy for the following:
A
a) b) c) d)
Students School Administrators Non-Teaching Personnel (guards, maintenance, etc.) Teachers
e) (Parents, Alumni, f) Visitors Off-Campus activities suchetc.) as field trips, camping’s, etc. etc. 3. The code of conduct has specific provisions to address potential risks to students such as: a) Disregarding abusive situation or behavior against agai nst children; b) Employing children as house helper or asking students to care for teacher’s children while children while in school; c) Relating with children in private for personal matters like studentteacher as “text mates” or Facebook friends; friends; d) Going out with students after school such as watching movies; e) Using green jokes or jokes with double meaning in the class; and f) Cultural beliefs (marrying children because it is acceptable based on one’s culture/religion, amicable settlement on child abuse cases) c ases) 4. Promotion or information dissemination of the school-based child protection and/or antibullying policies is done during school opening for: a) Students b) Teachers c) Non-Teaching Personnel d) Parents 5. There are written procedures to guide in conducting disciplinary proceedings in cases of offenses committed by pupils, students, or learners. 6. The School has adopted a conflict resolution mechanism that respects the rights of indigenous peoples, provided that they conform conform to child’s rights and the Department issuances on child protection. 7. There is an established system for identifying students who may be suffering ffrom rom significant harm based on physical, emotional, or behavioral signs.
8. Has developed and implemented a school-based referral and monitoring system to address child abuse and bullying cases. 9. There is an existing record of all proceedings related to bullying and child abuse cases using Intake Sheetto (Annex B ofcases DO 40, 2012 or Appendix B of using DO 18,the s. 2015) appropriate. 10. the Records related complex of s. child abuse and bullying Intakeas Sheets (Annex A of DO 40, s. 2012 or Appendix B of DO 18, s. 2015) are well-kept and separate from simple cases. 11. The school has submitted its consolidated reports on bullying and child abuse cases to the Division Office a week after the opening of each school year. 12. Has mapped out available resources in their community for possible linkages or networking for cases needing referrals, etc. 13. Has an active coordination with WPCD, DSWD, and other government and Non-Government Organizations (NGO). 14. Has a clear policy on the use of positive and non-violent discipline for children. 15. There is an organized Child Protection Committee (CPC) in the school. 16. There is an annual capacity building activities for the members of the CPC: a) Guidance Counselor/Designated Guidance Teacher b) Representative of the Students c) Representative of the Parents d) Representative of the Barangay e) Representative of the Teachers 17. The CPC is meeting regularly to discuss appropriate interventions and/or responses to school problems on bullying and child abuse cases and other concerns. 18. The school with its CPC has initiated information dissemination programs and organized activities for the protection of children from abuse, exploitation, violence, harm, and bullying. 19. There is a strong student participation in the promotion of child protection and anti-bullying
policies of the school. 20. There is a feedback mechanism in the school to monitor the implementation of the Child Protection and/or Anti-Bullying policies.
Respectfully Submitted:
___________________________________ ______________________ _______________________ ______________ ____ Signature above Printed Name of School Head
Enclosure B-1 DIVISION CONSOLIDATED REPORT ON INCIDENTS OF BULLYING SCHOOL YEAR ______________ (Based on Enclosure 2A of DepEd Memorandum No. 59, s. 2015)
Division: __________________ __________________ Total Number of Public Schools: ________ Elementary: ________ Secondary: _________ Total: ________
School
Physical M
I.
Public A. Elementary 1. 2.
Sub-Total (Public Elementary): B. Secondary
F
Total Number of Private Schools: ________ Elementary: _________ Secondary: __________ Total: ________ Nature of Bullying Gender Cyber Social -Based Bullying M
F
M
F
M
F
Retaliation M
F
No. of Bullying Incidents Total Total No. of No. of Total Male Female Victims Victims
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