Form 1: Classroom Level

NATIONAL SCHOOL DEWORMING MONTH (1ST DOSE JULY 2017)

Region: Division: District:

School ID:
Name of School:
Enrolment: Grade Level and Section:

4 P's Beneficiaries Dewormed Actions

No. Name of Pupil/Student Remarks
4 P's Non- 4 P's 4 P's Non- 4 P's Taken
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45

Accomplished by : Noted by:

Class Adviser: Grade Level Chairman

Date Accomplished:
Form 2: School Level

NATIONAL SCHOOL DEWORMING MONTH (1ST DOSE JULY 2017)

Region: Division: District:

School ID:
Name of School:

No. of Pupils/
4 P's Beneficiaries
Grade Level Students Dewormed Remarks
4 P's Non- 4 P's 4 P's Non- 4 P's

Kinder

Grade 1

Grade 2

Grade 3

Grade 4

Grade 5

Grade 6

TOTAL

Accomplished by :

School Principal

Date Accomplished:

Noted by:

District Supervisor
Form 2: School Level

NATIONAL SCHOOL DEWORMING MONTH (1ST DOSE JULY 2017)

Region: Division: District:

School ID:
Name of School:

No. of Pupils/
4 P's Beneficiaries
Grade Level Students Dewormed Remarks
4 P's Non- 4 P's 4 P's Non- 4 P's

Grade 7

Grade 8

Grade 9

Grade 10

Grade 11

Grade 12

TOTAL

Accomplished by :

School Principal

Date Accomplished:

Noted by:

District Supervisor