Quality Form Document Code:

CAR-QF-ESSD-06
Revision: 00
Oplan Kalusugan sa DepEd Effectivity date: 06-18-2018
Accomplishment Report Form
(Revised OKD Form C) ESSD Section: School Health Section
OKD Form C
Region/Division: Period covered:
Office Address:
Office Telephone Number: Mobile Number:
Fax Number: Email Address:
(Please check appropriate box)
Number of Schools in the Region/ Division: Elementary:
Secondary:
TOTAL:

A. SUMMARY OF SCHOOLS AND BENEFICIARIES COVERED

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

Teacher
s
NTP
Non-
plantilla
personn
el
TOTAL:

Table 2. Number of Schools Covered

TYPE
LEVEL TOTAL
Central Non- Multigrade Primary Complet With
School Central School/ e Junior Senior

OPLAN KALUSUGAN SA DEPED : Progress Report for the Period___________________________

 School Incomple HS Only HS
te
Elementary
Secondary
Integrated
School
TOTAL

B. ACCOMPLISHMENTS
(Use School Health Division Form 2 as basis for accomplishing this table)
1. Common Signs and Symptoms (as reported by nurses)
Sign/Symptom Number of Cases % of those assessed

2. Common Diseases (as Diagnosed by medical doctors)

Diagnosis Number of Cases % of those assessed

3. Common Dental Problems (as diagnosed by Dentists)

Diagnosis Number of Cases % of those assessed

4. Visual/Auditory Assessment
4.a. Vision Screening
5. Grade Sex Enrolme No. No. No. No. Remark
nt Assesse Passed Failed referred s
d
Kinder M
OPLAN KALUSUGAN SA DEPED : Progress Report for the Period___________________________
 F
I / VII M
F
II/ VIII M
F
III/ IX M
F
IV/ X M
F
V / XI M
F
VI /XII M
F
SPED/ M
ALS F
TOTAL M
F

4.a. Auditory Screening

Grade Sex Enrolme No. No. No. No. Remark
nt Assesse Passed Failed referred s
d
Kinder M
F
I / VII M
F
II/ VIII M
F
III/ IX M
F
IV/ X M
F
V / XI M
F
VI /XII M
F
SPED/ M
ALS F
TOTAL M
F

6. Nutritional Status
5.a. BASELINE NUTRITIONAL STATUS
5.a.1. Baseline for Elementary Learners
Grad Se Enrol No. SW/S W/U N OW OB SSt St N T
e x ment Assesse U
d
Kinde M
r F
I M
F
II M
F

OPLAN KALUSUGAN SA DEPED : Progress Report for the Period___________________________

III M
F
IV M
F
V M
F
VI M
F
SPED M
F
TOTA M
L F

5.a.2. Baseline for Secondary Learners

Grad Se Enrol No. SW/S W/U N OW OB SSt St N T
e x ment Assesse U
d
VII M
F
VIII M
F
IX M
F
X M
F
XI M
F
XII M
F
TOTA M
L F

5.b. ENDLINE NUTRITIONAL STATUS

5.b.1. Endline for Elementary Learners
Grad Se Enrol No. SW/S W/U N OW OB SSt St N T
e x ment Assesse U
d
Kinde M
r F
I M
F
II M
F
III M

OPLAN KALUSUGAN SA DEPED : Progress Report for the Period___________________________

 F
IV M
F
V M
F
VI M
F
SPED M
F
TOTA M
L F

5.b.2. End line for Secondary Learners

Grad Se Enrol No. SW/S W/U N OW OB SSt St N T
e x ment Assesse U
d
VII M
F
VIII M
F
IX M
F
X M
F
XI M
F
XII M
F
TOTA M
L F

7. Data from the Other Priority Programs

6.a. SCHOOL BASED FEEDING PROGRAM (SBFP)
6.a.1. SBFP Coverage: Schools
Division/D Assessed NUMBER OF NUMBER OF SCHOOLS Number
istrict SCHOOLS from Baseline NS SY Implementing SBFP of
2018 - 2019 CY 2018 Schools
not
covered
by SBFP
With For TOTAL With For TOTAL
SW/W PPAN SBFP (K- PPAN
Learners Only: 6) Only:
(K-6) With with
Kinder Kinder
Learners Only
SBFP
OPLAN KALUSUGAN SA DEPED : Progress Report for the Period___________________________
 6.a.2. SBFP Coverage: Learners
LEVE Number of Learners Number of Learners for SBFP CY 2018 NUMBER
L from Baseline NS of SW/W
SY 2018-2019 Learners
Not
Covered
by SBFP
Sever Waste TOTAL Sever Wast TOTAL Other PPA
ely d ely ed Target N
Waste Waste s
d d
KIND
ER
GRA
DE 1
GRA
DE 2
GRA
DE 3
GRA
DE 4
GRA
DE 5
GRA
DE 6
TOT
AL

6.a.3. SBFP Nutritional Status

Number of Beneficiaries with Number of Beneficiaries with
LEVEL Baseline NS of Endline NS of %
Rehabili
tated
Severel Wast Nor TOTA Sever Was Norm Ove TOT
y ed mal L ely ted al r AL
Wasted Wast wei
ed ght
KINDER
GRADE
1
GRADE
2
GRADE
3
GRADE
4
GRADE
5
GRADE
6

OPLAN KALUSUGAN SA DEPED : Progress Report for the Period___________________________

TOTAL

6.a.4 SBFP Schools with Gulayan sa Paaralan

NUMBER of schools with
Number of Schools with Number of SBFP and GPP:
Division/Distric SBFP Schools with % Contribution of GPP to
t SBFP SBFP expenses
All PPAN TOTAL implementin 0- 5- 25- >50
Grade Kinder g GPP 4% 24% 49% %
Levels Only

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.

6.b. NATIONAL DRUG EDUCATION PROGRAM (NDEP)

Activity Division/Distri No. of Schools No. of Participants/

ct Members/ Coaches/
Advisers

Elementary Highschool Teachers/ Learners

NTP

STEP

Barkada
Kontra
Droga

Lakas Isip
Ing
Kabataan

Red Cross
Youth

Others:

TOTAL

6.c. ADOLESCENT REPRODUCTIVE HEALTH (ARH)

6.c.1 Teenage Pregnancy Data in Public Schools (June 2018 – March 2019)
Division/Dist Scho Grad No. of No. of learners: No. of learners: Impregnat

OPLAN KALUSUGAN SA DEPED : Progress Report for the Period___________________________

rict ol e pregna Trimester of Quarter of CY or:
level nt Pregnancy at Reported for Number
learner first clinic first clinic
s consultation/ consultation/
referral referral
1st 2nd 3rd 1st 2nd 3rd 4th Mino Adu
r lt

6.c.2 Status Of Pregnant Learners (June 2018 – March 2019)

Division/District School ACCESS TO EDUCATION ACCESS TO HEALTH
SERVICES
No. In No. On No. No. to No. No. Lost
School ADM Droppe Barang with to
d ay RHU/ Private Follow
MHSO OB up

6.c.3 ARH Activities

Activity Division/Distri No. of Schools No. of Participants/

ct Members/ Coaches/
Advisers

Elementary High school Teachers/ Learners

NTP

Teen
Center

HIV/ AIDS
trainings/
lectures

Mental
Health
Trainings/
Lectures

Red Cross
Youth
OPLAN KALUSUGAN SA DEPED : Progress Report for the Period___________________________
 Others:

TOTAL

6.d. WASH IN SCHOOLS (WINS)

Division/ Total Number of Schools evaluated REMARKS
District Number with Three-Star Approach
of Rating
Schools 0 1 2 3

C. SUMMARY OF VOLUNTEER SERVICES

Table . Number of Partners Involved

Name of No. of Learners No. of School
Organizati Number of Number of Personnel
on/ Volunteers Schools Examin Treated Examine Treated
Affiliation/ Served ed d
Institution

D. Donations/ Resources Generated

(Add Additional Sheets, If Needed.)
Type of Donations Quantity Estimated Cost

E. SIGNIFICANT EVENTS OF SBFP, NDEP, ARH, WINS AND OTHER HEALTH AND NUTRITION
PROGRAMS/ EXPERIENCES/ GOOD PRACTICES
(Use separate sheets, If needed)

What happened? Who were When Outcome: What is/are its important
involved ? contribution to the OK sa DepEd
Program of the school?

OPLAN KALUSUGAN SA DEPED : Progress Report for the Period___________________________

 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)

Prepared by: Noted:

_____________________________________________________ ___________________________________________________________
OK sa DepEd Focal Person Regional Director/ Schools Division Superintendent
Date:_________________
Submit completed to the RO by 1st week of April/ CO by 1st week of May

OPLAN KALUSUGAN SA DEPED : Progress Report for the Period___________________________