Incident Report_Template.xlsx

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1	SCHOOL INCIDENT REPORT: (Insert Name of Incident) as of (Insert Complete Date)
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3	Region: .				School Name: .
4	Division: .				School ID: .
5	District: .
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7	Nature of Incident:	(Provide brief narrative of what and how the incident transpired. Include parties involved with complete name/s, complete name/s of organization/s and designation/s)
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18	Complete Date and Time of Incident:			School Used as Evacuation Center (EC) Due to the Incident		No. of Classrooms used as EC:	No. of Days used as EC:	No. of TLS Needed:
19	Complete Date and Time of Incident:			School Used as Evacuation Center (EC) Due to the Incident		(Indicate N/A if no)	(Indicate N/A if no)	(Indicate N/A if no)
20	Damages Incurred Due to the Incident	Classrooms (academic):		School furniture (learners' and teachers' tables and chairs, desks, armchairs only)		Learning materials:	Computer equipment used for instruction (provided by DepEd through the DepEd Computerization Program only):
21		No. Damaged	Classification			Learning materials:
22		(If yes, indicate number of damaged classrooms. Indicate N/A if no)	(If yes, indicate if Totally Damaged, Partially Damaged (Major), or Partially Damaged Minor. Indicate N/A if no.)	(If yes, indicate number of damages per set. Indicate N/A if no.)		(Yes or N/A only. If yes, accomplish the School Consolidation Sheet for Damaged Learning Resources)	(If yes, indicate number of damages of specific equipment. Indicate N/A if no.)
23	Casualties Incurred Due to the Incident	Personnel:				Learners:
24		Complete Name		Designation/ Position	Status	Complete Name	Grade Level	Status
25		(Indicate N/A if no)		(Indicate N/A if no)	(If yes, indicate if deceased, injured, missing, or displaced. Indicate N/A if no)	(Indicate N/A if no)	(Indicate N/A if no)	(If yes, indicate if deceased, injured, missing, or displaced. Indicate N/A if no)
26	Actions Taken:	(Provide list of actions taken with complete dates and time, if any and available. Indicate N/A if no)
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31	Needs Identified Requiring Assistance:	(If yes, indicate needs other than those mentioned in the Damages and TLS Needs sections. Indicate N/A if no.)
32	*Note: 1. This template should only be utilized for small scale hazards affecting only the school. Schools should accomplish and submit the Rapid Assessment of Damages Report (RADaR) Forms 1 and 2 following the instructions in DO 21, s. 2015 for all large scale hazards (tropical cyclones, earthquakes, etc.); and, 2. Other appropriate attachments should be included, such as but not limited to PNP report (blotter)/BFP report/LGU report (as applicable), and pictures of damages due to the incident (if any).
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35	Prepared by:					Approved by:
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39	School DRRM Coordinator					School Head/Principal
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