FORM D1: Monitoring Form for COVID-19 Volunteer Initiatives of Organizations/Establishments
Thank you for volunteering or donating for the country's COVID-19 Response Efforts. For monitoring purposes, we would like to gather information on the volunteer service rendered or donations given by individual volunteers and organizations. Rest assured that the information will be used with utmost confidentiality and for monitoring purposes.
In compliance with Administrative Order No. 27, s. 2020, we strongly encourage donors of medicines, medical equipment and supplies, and other health products to address COVID-19, whether given to the National Government as a whole or to the Department of Health (DOH) to inform the Office of Civil Defense (OCD) directly for inventory purposes and to help the Government ensure equitable allocation and distribution of assistance.
(Maraming salamat sa pagiging volunteer o pagbibigay ng donasyon bilang tulong sa COVID-19 response ng ating bansa. Upang masubaybayan ang mga tulong na ito, nais naming kumuha ng impormasyon sa mga serbisyo o donasyon na ibinigay ng mga indibidwal at organisasyon. Ang nasabing datos ay mananatiling pribado at gagamitin lamang para sa monitoring.
Bilang pagsunod sa Administrative Order No. 27, s. 2020, hinihikayat namin ang mga nagbigay ng donasyong gamot, kagamitang medikal, at iba pang produktong pangkalusugan para sa pagtugon sa COVID-19 sa national government o Department of Health na ipagbigay alam sa Office of Civil Defense para maitala at masiguro ang tamang alokasyon at distribusyon.)
* Required
GENERAL INSTRUCTIONS
Please answer N/A if the question is not applicable. If you would like to provide additional information which cannot be captured by the questions, please include these under the " Additional Information" which can be found near the end of this form.
(Maaaring sumagot ng "N/A" kung hindi naaangkop ang tanong. Kung nais mong magbigay ng karagdagang impormasyon na hindi saklaw ng tanong sa bahaging ito, maari mong ilagay ang mga ito sa " Karagdagang Impormasyon" na matatagpuan malapit sa dulo ng form na ito.)
Name of Organization/Institution
*
Your answer
Name of Respondent or Contact Person
*
Your answer
Designation of Contact Person
*
Your answer
Type of Organization (Klase ng Organisasyon)
*
Non-Government Organization
Professional Association (Samahan ng mga propesyonal)
Academe-based/Alumni Association (Samahan sa loob ng paaralan/Samahan ng nagsipagtapos)
Church-based/Religious (Samahan na kaakibat ng relihiyon)
Employees’ Association/Labor Union (Samahan ng mga empleyado/Unyon ng manggagawa)
Private Company / Corporation (Pribadong kompanya/korporasyon)
Others (Iba pa)
If others, please specify (Kung iba pa, tukuyin)
Your answer
Complete Address (House No., Street, Subdivision, Barangay, City/Municipality, Province)
Block and Lot No./ Floor and Building No.
Your answer
Street/Subdivision
Your answer
Barangay
Your answer
City/Municipality
*
Your answer
Province (If your organization is based in NCR, please answer N/A)
Your answer
Region
*
Choose
National Capital Region ( Metro Manila)
Cordillera Administrative Region
Region I
Region II
Region III
Region IV-A ( CALABARZON)
MIMAROPA
Region V
Region VI
Region VII
Region VIII
Region IX
Region X
Region XI
Region XII
Region XIII (Caraga)
Bangsamoro Autonomous Region in Muslim Mindanao
E-mail address
*
Your answer
Telephone/Mobile Number
*
Your answer
Website
Your answer
Facebook URL/Username
Your answer
For other social media accounts, please provide username:
Your answer
Type of assistance for COVID-19 Response (Klase ng tulong na ibinigay para sa pagtugon sa COVID-19
*
Volunteer Service (Boluntaryong serbisyo)
Donation (Donasyon)
Others
Required
Other types of assistance, please specify (Kung iba pa, tukuyin).
Your answer
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