Republic of the Philippines
Department of Education
Region [X] – Division of [Name of Division]
[Name of School]
School ID: [XXXXXXX]
INCIDENT REPORT ON BULLYING
SY [20XX – 20XX]
Date: [Insert Date]
School: [Name of School]
Address: [School Address]
Report Summary:
In compliance with the provisions of DepEd Order No. 40, s. 2012 (Child Protection Policy) and
DepEd Order No. 55, s. 2013 (Anti-Bullying Act of 2013), the undersigned hereby submits the
Incident Report on Bullying for the School Year [20XX – 20XX].
Based on the consolidated monitoring, class advisories, and school guidance records, the school
has recorded ZERO (0) reported cases of bullying for the said period.
Interventions/Preventive Measures Undertaken by the School:
1 Conducted orientation and seminars on Child Protection Policy and Anti-Bullying Law for
teachers, learners, and parents.
2 Integrated lessons on respect, empathy, and responsible online behavior through the
Homeroom Guidance Program.
3 Established a functional Child Protection Committee (CPC) to monitor and respond to possible
cases.
4 Provided accessible reporting mechanisms (reporting box, class advisers, guidance office).
5 Increased supervision in bullying-prone areas (restrooms, hallways, playgrounds).
Certification:
This report certifies that no incidents of bullying were reported, filed, or recorded in [Name of
School] for the period indicated. The school continues to strengthen preventive measures to
maintain a safe and child-friendly learning environment.
Prepared by:
[Name of Teacher/Guidance Advocate]
Child Protection Committee (CPC) Member
Noted by:
[Name of School Head]
School Principal