Republic of the Philippines
Department of Education
MIMAROPA REGION
SCHOOLS DIVISION OF PALAWAN
INCIDENT REPORT FORM
Reported by: Date:
Division: Palawan
INCIDENT INFORMATION
Type of Incident: COVID-19 Date and Time of
EXPOSURE Incident: JUNE 3,2021
Location Coron, Palawan
Details of Incident:
As of June 3, 2021 Raymund Gumbilan (learner) stated that he was interacted with her
employer who has Covid-19.
Name/Role/Contact of Parties Involved:
1. RAYMUND GUMBILAN/ STUDENT/ _____________________________
2. _____________________________________________________________________
3. _____________________________________________________________________
Action Taken:
Prepared by: Received by:
MARY GRACE M. HEREDERO GLENDIE LEE PELAYO-BUASAG
Adviser School Information Coordinator
___________________________ ___________________________
Date Date
CORON SCHOOL OF FISHERIES
Bgy. Poblacion 1, Coron, Palawan 5316
Mobile No.: 09063263012/09176342091
Email Address:
[email protected]