Document Code:

Quality Form
Revision:
Oplan Kalusugan sa DepEd
Accomplishment Report Form Effectivity date: 03-1-2019

(Revised OKD Form C) BLSS-School Health Division

Region/Division: Period Covered:

Office Address:
Office Telephone Number: Mobile Number:
Fax Number: Email Address:
Number of Schools in the Region/Schools Division: Elementary:
Secondary:
TOTAL:

A. SUMMARY OF SCHOOLS AND BENEFICIARIES COVERED

Table 1. Number of Learners and School Personnel Covered by DepEd and Volunteers
Total Enrolment Actual Medically Examined With Findings Given Interventions
Grade Level
M F M F M F M F
Kinder
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Grade 7
Grade 8
Grade 9
Grade 10
Grade 11
Grade 12
TOTAL:
Grand TOTAL:

Teachers
Non-Teaching
Personnel
Non-plantilla
personnel
TOTAL:

Table 2. Number of Schools Covered

TYPE
Central School Non-Central Multigrade Primary Complete Junior HS with Stand-alone
Grade Level School School/ Junior HS only Senior HS Senior HS TOTAL
Incomplete

Elementary
Secondary
Integrated School
TOTAL

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B. ACCOMPLISHMENTS
1.a SCHOOL BASED FEEDING PROGRAM (SBFP) & NUTRITION-SUPPORT
1.a.1. SBFP Coverage: Schools
Schools Division Assessed NUMBER OF SCHOOLS from NUMBER OF SCHOOLS Implementing SBFP
Offices (SDOs) Baseline NS CY 2018 Number of
Schools not
With SW/W With SS/S that TOTAL With SBFP Covered by TOTAL covered by
Learners (K-6) are not SW/W (K-6) Partners SBFP &
Learners (K-6) partners

1.a.2. SBFP Coverage: Learners

Grade Level TARGET ACTUAL
Severely Wasted Wasted Severely Stunted Stunted TOTAL
that are not SW/W that are not SW/W

Kinder
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
TOTAL

1.a.3. SBFP Funds

Schools Division Offices (SDOs) Budget Allocation as per GAA Funds Utilized Percent Utilization
(col 3/2*100%)

1.a.4. SBFP Nutritional Status - Before & After Feeding

Grade Level Number of Beneficiaries After Feeding
Number of %
Beneficiaries fr Severely Overweight +
Wasted Normal TOTAL Rehabilitated
Table 1.a.2 Wasted Obese
Kinder
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
TOTAL

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 1.a.5. SBFP Schools with Gulayan sa Paaralan
NUMBER of Schools with SBFP and GPP:
Number of % Contribution of GPP to SBFP expenses
Schools Division Offices Schools with SBFP
(SDOs) implementing 0-4% 5-24% 25-49% >50%
GPP

Note: On the GPP record, all vegetables used for SBFP should be itemized with corresponding quantity and cost. The Total cost of
vegetables used divided by (number of beneficiaries X 16.00 X 120 days) X 100 = % contribution to the feeding program

1.a.5. Gulayan sa Paaralan

No. of Schools Given Financial Pecentage of Schools (col
Schools Division Offices (SDOs) Total no. of Schools Assistance 3/2*100%)

2. NATIONAL DRUG EDUCATION PROGRAM (NDEP)

Schools Division Offices No. of Participants/ Members/ Coaches/
Activity (SDOs) No. of Schools Advisers

Elementary High School Teachers/NTP Learners

Systematic Training
for Effective
Parenting

Barkada Kontra
Droga
Universal
Preventive
Curricula

Life Skills Training

Orientation on RA
9165

Tobacco Control

Red Cross Youth

Kabataan

Lakas Isip lng

Others:

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3. ADOLESCENT REPRODUCTIVE HEALTH (ARH)
3.a. Teenage Pregnancy Data in Public Schools (June 2019 - March 2020)

No. of learners:
No. of Trimester of No. of learners: Quarter of CY
Schools Division Grade Impregnator:
School pregnant Pregnancy at first Reported for first clinic
Offices (SDOs) Level Number
learners clinic consultation/ consultation/ referral
referral

1st 2nd 3rd 1st 2nd 3rd 4th Minor Adult

3.b Status of Pregnant Learners (June 2019 - March 2020)

ACCESS TO EDUCATION ACCESS TO HEALTH SERVICES
Schools Division Offices No. to
School No. with No. Lost to
(SDOs) No. In School No. On ADM No. Dropped Barangay Private OB Follow up
RHU/ MHSO

3.c. ARH Activities

No. of Participants/ Members/
Schools Division Offices No. of Schools
Activity Coaches/ Advisers
(SDOs)
Elementary High school Teachers/ NTP Learners

Teen Center

HIV /AIDS
trainings/ lectures
Mental Health Trainings/
lectures

Red Cross Youth

Others:

TOTAL

4. WASH IN SCHOOLS (WINS)

Schools Division Total Number Number of Schools evaluated with Three-Star Approach REMARKS
Offices (SDOs) of Schools Rating

0 1 2 3

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5. SCHOOL MENTAL HEALTH
5.a. Licensed Mental Health Professionals

Number of Registered Number of Registered Number of Licensed

Schools Division Offices (SDOs) Other (Specify)
Guidance Counselors Psychologists Psychometricians

5.b. Other Certified Mental Health Professionals

Number of Trained Personnel
Formal/ Certificate Training
Other non-teaching
Health personnel Teaching personnel
personnel

5.c. Capacity Building Activities Conducted

Participating Schools No. of Participating Schools No. of Participants

Activity Conducted Division Offices
(Specify title of activity) (SDOs) Elementary High school NTP Teachers Learners

TOTAL

6. MEDICAL-DENTAL-NURSING SERVICES
(Use School Health Division Form 5as basis for accomplishing this table)
6.a. Ten Most Common Signs and Symptoms (as reported by nurse)
Sign/Symptom Number of Cases % of those assessed

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6.b. Ten Most Common Diseases (as Diagnosed by Medical Doctors)
Diagnosis Number of Cases % of those assessed

6.c. Ten Most Common Dental Problems (as Diagnosed by Dentists)

Diagnosis Number of Cases % of those assessed

6.d. Dental Service Accomplishment Report

Schools Number of Children

No. of Clasroom
Division Offices Enrolment Health Talks Orally examined With Defects Caries Free Underwent
Scaling
Given Fluoride
Application
Underwent
Extraction
Given Filling Treated
Given
(SDOs)

NUMBER OF TEETH (TREATMENT DONE)

Schools EXTRACTION FILLING PERMANENT TEMPORARY
Division Offices
(SDOs) Pit & ART (Glass Sound
Permanent Temporary Fissure ZOE SyF D M F d
Ionomer) Teeth
Sealant

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6.e. School-Based Immunization Program
No. Immunized
Grade Level Sex Enrollment 1st Dose 2nd Dose REMARKS
MR Td MR Td
M
Grade 1
F
M
Grade 7
F

No. Immunized
Grade Level Sex Enrollment 1st Dose 2nd Dose REMARKS
HPV HPV

( For 9 yers old &

Grade 4 F above only)

6.f. Deworming Program

1st Dose 2nd Dose
Grade Level Sex Enrolment
No. Dewormed % Enrolment No. Dewormed % Enrolment
Kinder M
F
Grade 1 M
F
Grade 2 M
F
Grade 3 M
F
Grade 4 M
F
Grade 5 M
F
Grade 6 M
F
M
Grade 7
F
M
Grade 8
F
M
Grade 9
F
M
Grade 10
F
M
Grade 11
F
M
Grade 12
F
M
SPED
F
M
ALS
F
TOTAL M
F

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6.g. Weekly Iron Folic Acid (WIFA) Supplementation Program

Grade Level Enrolment No. Given IFA % Enrolment

Grade 7
Grade 8
Grade 9
Grade 10
Grade 11
Grade 12
SPED
ALS
TOTAL

6.h. Visual/Auditory Assessment

6.h.1 Vision Screening

Grade Level Sex Enrolment No. Assessed No. Passed No. Failed No. Referred Remarks

Kinder M
F
Grade 1 M
F
Grade 4 M
F
Grade 7 M
F
Grade 10 M
F
TOTAL M
F

6.h.2. Auditory Screening

Grade Sex Enrolment No. Assessed No. Passed No. Failed No. Referred Remarks

Kinder M
F
Grade 1 M
F
Grade 4 M
F
Grade 7 M
F
Grade 10 M
F
TOTAL M
F

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6.i. Nutritional Status
6.i.1. BASELINE NUTRITIONAL STATUS
6.i.1.a Baseline for Elementary Learners
Grade Sex Enrolment No. Assessed SW/SU W/U N OW Ob SSt St N T
Kinder M
F
1 M
F
2 M
F
3 M
F
4 M
F
5 M
F
6 M
F
SPED M
F
TOTAL M
F

6.i.1.b Baseline for Junior and Senior High School Learners

Grade Sex Enrolment No. Assessed SW/SU W/U N OW Ob SSt St N T
7 M
F
8 M
F
9 M
F
10 M
F
11 M
F
12 M
F
TOTAL M
F

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 6.i.2. ENDLINE NUTRITIONAL STATUS
6.i.2.a Endline for Elementary Learners
Grade Sex Enrolment No. Assessed SW/SU W/U N OW Ob SSt St N T
Kinder M
F
1 M
F
2 M
F
3 M
F
4 M
F
5 M
F
6 M
F
SPED M
F
TOTAL M
F

6.i.2.b Endline for Junior and Senior High School Learners

Grade Sex Enrolment No. Assessed SW/SU W/U N OW Ob SSt St N T
7 M
F
8 M
F
9 M
F
10 M
F
11 M
F
12 M
F
TOTAL M
F

C. SUMMARY OF VOLUNTEER SERVICES

Table . Number of Partners Involved

No. of Learners No. of School Personnel
Name of Organization/ Affiliation/ Number of Number of
Institution Volunteers Schools Served Examined Treated Examined Treated

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D. DONATIONS/ RESOURCES GENERATED
(Add Additional Sheets, If Needed.)

Type of Donations Quantity Estimated Cost

E SIGNIFICANT EVENTS OF SBFP, NDEP, ARH, WINS, SMH, AND OTHER HEALTH AND NUTRITION PROGRAMS/
EXPERIENCES/ GOOD PRACTICES
(Use separate sheets, If needed)
What happened? Who were involved? When Outcome: What is/are its important contribution to
the OK sa DepEd Program of the school?

F. LESSONS LEARNED G. SUGGESTIONS TO STRENGTHEN OK SA DEPED

PROGRAM
(Include support needed from Central, Region, and Division Office that can
increase the impact of OK sa DepEd Program in the schools)

H. PROPOSED PLAN OF ACTION FOR NEXT OK SA DEPED HEALTH SERVICES

I. PHOTOS (Before, During and After)

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Prepared by: Noted:

OK sa DepEd Focal Person Director IV

Date:
Submit completed on 1st week of May

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