Annex 4 Republic of the Philippines

Department of the Interior and Local Government

BUREAU OF JAIL MANAGEMENT AND PENOLOGY
REGIONAL OFFICE XIII-CARAGA
Libertad, Butuan City

Name of Jail Facility: Butuan City Jail Female Dormitory

Address of Jail Facility: Jail Road, Libertad, Butuan City
Name of Facilitators: JO2 Maria Teresa L Auza and JO1 Shari Gail Gardones

Form 3: Monitoring of KatataganKontraDrogasaKomunidad (KKDK) Graduates

Age Sex Criminal Date of Name of Length of Date of Status

No Name case Commitment illegal drug use graduatio (Please refer Remarks
drug of (in months) n from to Note 2 for
choice KKDK Answers to
this column)

1 Negative Still on module 9

2
3
4
5
6
7
8
9
10
11
12
Note 1: The KKDK facilitator must accomplish this form for his/her own KKDK group on monthly basis reckoned the date of KKDK graduation, certified by
the warden and submit to DWD thru the Regional

Note 2:Answers for the“Status” column

 A. Released thru Plea Bargaining using the KKDK certification as proof of drug rehabilitation
B. Still on Detention awaiting result of plea bargaining
C. Did not avail of Plea Bargaining
D. Transferred to other facilities (state the name of facility)
E. Others (provide details in the “Remarks” column)

Prepared by: Verified by: Noted by:

JO2 Maria Teresa L Auza JCINSP MARGIE D CANANGCAAN JSSUPT REVELINA A SINDOL
KKDK Facilitator Jail Warden Regional Director