Page1

BADAC DATA CAPTURE FORM 1

INDICATOR POSITION FIRSTNAME LASTNAME SEX BIRTHDATE CIVILSTATUS ADDRESS CONTACT#

Chairperson/
Punong Barangay
Vice-Chairperson/
Peace & Order
Committee Chair
Members:
Chair of Women &
Family Committee
BADAC is SK Chairperson
composed of
School Principal/
seven (7)
Representative
members
Brgy Chief Tanod
NGO / CSO
Representative
Faith-based Org
Representative
Adviser:
Local PNP Chief/
Representative
Chairperson/
Peace & Order
BADAC Committee Chair
Committee on Members:
Operations is
Brgy Chief Tanod
organized
BADAC Auxiliary
Refer to BADAC Auxiliary Team Profile
Team
Chairperson/
Women & Family
Committee Chair
Members:
BADAC
SKChairperson
Committee on
Advocacy is School Principal/
organized Representative
NGO / CSO
Representative
Faith-based Org
Representative
 Page2
BADAC DATA CAPTURE FORM 1

INDICATOR POSITION FIRSTNAME LASTNAME SEX BIRTHDATE CIVILSTATUS ADDRESS CONTACT#

BADAC
Auxiliary Team
(BAT) is
organized

Note:Use additional page if necessary. BAT shall be composed of one member per 80 residents; 25 members per 2,000 residents.
INDICATOR UNITOFCLUSTER FIRSTNAME LASTNAME SEX BIRTHDATE CIVILSTATUS ADDRESS CONTACT#

BADAC House
Clusters are
organized

Note:Use additional page if necessary. Examples of Unit of Cluster are by purok, by sitio, by block, by zone, by street, etc.
CONCURRENT
INDICATOR DESIGNATION FIRSTNAME LASTNAME SEX BIRTHDATE CIVILSTATUS ADDRESS CONTACT#
(ifapplicable)
Barangay Duty
Officers are
designated
Note:Use additional page if necessary.Concurrent Designation refers to the primary appointment/item of the designated Brgy Duty Officer in the barangay,e.g.Barangay Health
Worker, VAWC Desk Officer, etc.
 Page3
BADAC DATA CAPTURE FORM 2
DURATION SPEAKER/
INDICATOR ACTIVITY TITLE VENUE LEADORGANIZER
DATE(MM/DD/YYYY) TIME FACILITATOR
Trainings Attended
by Punong
Barangay on
Strengthening
BADACs
Note:Use additional page if necessary.
DURATION SPEAKER/
INDICATOR ACTIVITY TITLE VENUE LEADORGANIZER
DATE(MM/DD/YYYY) TIME FACILITATOR
Trainings/
Planning Session
Attended by
Punong Barangay
on CSAR
Note:Useadditionalpageifnecessary.
DURATION SPEAKER/ NO.OF
INDICATOR ACTIVITYTITLE VENUE
DATE(MM/DD/YYYY) TIME FACILITATOR MALE FEMALE
Trainings
Conducted by
BADAC for House
Cluster Leaders
Note:Useadditionalpageifnecessary.
DURATION SPEAKER/ NO.OF
INDICATOR ACTIVITYTITLE VENUE
DATE(MM/DD/YYYY) TIME FACILITATOR MALE FEMALE
Trainings
Conducted by
BADAC for BADAC
Auxiliary Team
Note:Useadditionalpageifnecessary.
DURATION SPEAKER/
INDICATOR ACTIVITYTITLE VENUE LEADORGANIZER
DATE(MM/DD/YYYY) TIME FACILITATOR
Trainings Attended
by Barangay Duty
Officers
Note: Use additional page if necessary.
 Page4
BADAC DATA CAPTURE FORM 3

DURATION NO.OFPARTICIPANTS
INDICATOR ACTIVITYTITLE VENUE PRESIDINGOFFICER
DATE(MM/DD/YYYY) TIME MALE FEMALE
Conduct of
BADAC
Consultative
Meetings
Note:Useadditionalpageifnecessary.
DURATION NO.OFPARTICIPANTS
INDICATOR ACTIVITYTITLE VENUE PRESIDINGOFFICER
DATE(MM/DD/YYYY) TIME MALE FEMALE

Conduct of
BADAC Monthly
Meetings

Note:Useadditionalpageifnecessary.
DURATION NO.OFPARTICIPANTS
INDICATOR ACTIVITYTITLE VENUE TARGETAUDIENCE
DATE(MM/DD/YYYY) TIME MALE FEMALE
Organization/Co-
organization of
Community-based
IEC Campaign
Activities
Note:Useadditionalpageifnecessary.
DURATION NO.OFPARTICIPANTS
INDICATOR ACTIVITYTITLE VENUE TARGETAUDIENCE
DATE(MM/DD/YYYY) TIME MALE FEMALE
Organization/Co-
organization of
School-based IEC
Campaign
Activities
Note:Useadditionalpageifnecessary.
 Page5
BADAC DATA CAPTURE FORM 3

DURATION NO.OFPARTICIPANTS
INDICATOR ACTIVITYTITLE VENUE TARGETAUDIENCE
DATE(MM/DD/YYYY) TIME MALE FEMALE

Conduct of Youth-
led IEC Campaign
Activities

Note:Useadditionalpageifnecessary.
DURATION NO.OFPARTICIPANTS
INDICATOR ACTIVITYTITLE VENUE TARGETAUDIENCE
DATE(MM/DD/YYYY) TIME MALE FEMALE

Conduct of CSO-
led IEC Campaign
Activities

Note:Useadditionalpageifnecessary.
DURATION NO.OFPARTICIPANTS
INDICATOR ACTIVITYTITLE VENUE TARGETAUDIENCE
DATE(MM/DD/YYYY) TIME MALE FEMALE
Organization/Co-
organization of
Activities in
Observance of the
IDADAIT
Note:Useadditionalpageifnecessary.
DURATION NO.OFPARTICIPANTS
INDICATOR ACTIVITYTITLE VENUE TARGETAUDIENCE
DATE(MM/DD/YYYY) TIME MALE FEMALE
Organization/Co-
organization of
Activities in
Observance of the
DAPC Week
Note:Useadditionalpageifnecessary.
 Page6
BADACDATACAPTUREFORM4
UNIFIEDBARANGAYREPORTONREFERRALACTION(UBRRA)

Dataprovidedhereinarethoserecordedwithinthemonthsof:JanuarytoJune()JulytoDecember()Year(YYYY):

NO.OFSURRENDERERS NO.OFREFERREDSURRENDERERS
INDICATOR INDICATOR
MALE FEMALE MALE FEMALE
TOTAL TOTAL
BELOW18 ABOVE18 BELOW18 ABOVE18 BELOW18 ABOVE18 BELOW18 ABOVE18

Submission of Updated
Submission of Updated Number
Number of Residents who
of ReferredSurrenderers
Surrenderred

NO.OFSURRENDERERSENROLLEDINWELLNESS&REC
STATUS/ STATUSANDNO.OFASSESSEDSURRENDERERS WELLNESS&
OVERYINTERVENTIONS
INDICATOR LEVELOF INDICATOR RECOVERY
RISK MALE FEMALE INTERVENTIONS MALE FEMALE
TOTAL TOTAL
BELOW18 ABOVE18 BELOW18 ABOVE18 BELOW18 ABOVE18 BELOW18 ABOVE18

General
Low
Interventions

Community-based
Mild Submissionof Treatment& Rehab
Submission of
Updated
Updated Number
Numberof
of Assessed HealthFacility-
Enrolled
Surrenderers basedOutpatient
Moderate Surrenderers Treatment&
Rehab
Inpatient
Severe Treatment&
Rehab

NO.OFSURRENDERERSWHOCOMPLETEDWELLNESS&REC
OVERYINTERVENTIONS Thepurposeofthisformistodeterminethenumberofsurrendererspersemester(January- June, July-
INDICATOR
MALE FEMALE December),andmonitorthenumberofwho,amongthosesurrenderers,havebeen
TOTAL referred,assessed,andwhohavecompletedanyWellnessandRecoveryPrograminterventions
BELOW18 ABOVE18 BELOW18 ABOVE18
SubmissionofUpdated withinthe6-monthtimeframe.Countingshallrestartattheonsetofthenewsemester;meaning,
NumberofSurrenderersWho thedataonthosewhosurrenderedintheprevioussemestershallnolongerbeaccountedinthe
CompletedWellness&Recover next,regardlessofwhethertheyhavebeenreferredorassessedinthefollowingsemester.
yInterventions
 Page7
BADACDATACAPTUREFORM5
COMMUNITYSUPPORT,AFTERCAREANDREINTEGRATION(CSAR)

Dataprovidedhereinarethoserecordedwithinthemonthsof:JanuarytoJune()JulytoDecember()Year(YYYY):

NO.OFCSARENROLLEES NO.OFCSARGRADUATES
INDICATOR INDICATOR
MALE FEMALE MALE FEMALE
TOTAL TOTAL
BELOW18 ABOVE18 BELOW18 ABOVE18 BELOW18 ABOVE18 BELOW18 ABOVE18
Submissionof
SubmissionofUpdated UpdatedNumberof
NumberofResidentsEnrolled ResidentsWho
inCSARProgram,orits Completedthe
equivalent CSARProgram,or
itsequivalent

ThepurposeofthisformistodeterminethenumberofresidentsenrolledinCSARProgram,oritsequivalent,persemester(January-June,July-December),andmonitorthenumberofwho,
amongthoseenrolled,havecompletedtheCSARprogramwithinthe6-monthtimeframe.Countingshallrestartat theonsetof thenewsemester;meaning,thedataonthoseenrolledin the
previoussemestershallnolongerbeaccountedinthenext,regardlessofwhethertheyhavebeenreferredorassessedinthefollowingsemes
 Page8
BADACDATACAPTUREFORM6
SUMMARYOFCONSOLIDATEDINFORMATIONREPORT
asperSection8ofDDBBoardRegulationNo.3,s.2017
Year(YYYY):

Dataprovidedhereinarethoserecordedwithinthemonthsof: JanuarytoMarch( ) ApriltoJune( ) JulytoSeptember () OctobertoDecember ( )

DRUGTRANSIT/ CLANDESTINE
DRUGPUSHER DRUGUSER/DEPENDENT DRUGSUPPLYAVAILABILITY
INDICATOR TRANSHIPMENTACTIVITY LABORATORY

PRESENT/ABSENT TOTAL PRESENT/ABSENT TOTAL PRESENT/ABSENT PRESENT/ABSENT PRESENT/ABSENT

Submissionof
UpdatedSummaryof CLANDESTINECHEMICAL MARIJUANACULTIVATION DRUGDEN,DIVEOR DRUGPROTECTOR/
CLANDESTINEDRUGWAREHOUSE
ConsodatedInformati WAREHOUSE SITE/PLANTATION RESORT CODDLER&FINANCIER
onReport (CIR)

PRESENT/ABSENT PRESENT/ABSENT PRESENT/ABSENT PRESENT/ABSENT PRESENT/ABSENT

 Republic of the Philippines
DEPARTMENTOFTHE INTERIORAND LOCAL GOVERNMENT
DILG-NAPOLCOM Center, EDSA cor.QuezonAve.,Quezon CityTelephone Number
(02) 925-1137
Email Address:badacfunctionality@gmail.com

BADAC CONSOLIDATED REPORT FORM (CRF)

for the Year

Region: Province: City/Municipality:

NAMES OF BARANGAY TOTAL POINTS LEVEL OF FUNCTIONALITY

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Note:Use additional page if necessary