SCHOOL:

SCHOOL ID:
SCHOOL ADDRESS:
(Please Check appropriate box)
Elementary )
Secondary
SCHOOL HEAD:
CONTACT NUMBER:
PTA PRESIDENT:
CONTACT NUMBER:
A. SCOPE OF REPAIR AND MAINTENANCE WORK COMPLETED BASED on SIP & DepEd Memo No. 41,
2015, Annex C (all accomplishments supported with pictures) (Please check appropriate column)
What was done?
Equipment

New
Construction

Replaced

1. Roofs/rain gutter
2. Walls/Ceilings
3. School Building Directory
4. Windows and Doors
5. Chairs/Desks Tables, and Blackboards
6. Comfort Rooms
7. Leaking Pipes
8. School Grounds/Landscaping
9. School Signs/signages
10. Electrical
11.Fire extinguisher (suspended outside)
12. School free from any sharp objects
13.Prepare directory of identified classroom
for evacuation
14. Drainage
15. Signages for on-going
construction/condemned buildings
16. Exit plan/signage of high story building
17 Post directory of emergency contact
18. Establish early warning devices in case of emergency

19.
20.
21.
22.

School equip with first aid kits

Vegetables garden
No. of trees planted
Waste depository (with segregation)

23. Storage room(with segregation of contents)

24. Disaster Organizational Chart
25. Others specify

B. DONATIONS / MATERIAL RESOURCES GENERATED (Use separate sheet, if needed)

Type of Donations
Source

Total

C. VOLUNTER SERVICES (Use separate sheets of daily attendance)

Name of
Number of Volunteers
Type of Volunteer
Individual/
Day
Day
Day
Organization
1
2
3
1. NGO
A. (PRIVATE SECTOR)
2. PTA
3. SGC
4. Gawad Kalinga
5. Corporation
6. Etc.
B. (COMMUNITY)
1. Parents
2. Alumni
3. Private Individual / Community Members
4. Religious Organization (Youth and Adult)
C. (Govt Agencies)LOCAL & NATIONAL
1. Congressional Officials and Staf
2. Provincials Officials
3. City Officials
4. Barangay Officials
5. SK Officials
6. Provincial /City Employees
7. Fireman / PNP etc.
8. AFP (PA, Marine, etc)
9. Barangay Workers
10. Other Volunteers
TOTAL
D. ESTIMATED COST OF VOLUNTEER SERVICES RENDERED. (Use separate sheets, if needed)
Type of Services
Rate per
Rate per
Total Number
Total Number
Day
Hour
of Volunteers
of Hours
Rendered
Masonry
360
45
Carpentry
360
45
Plumbing
360
45
Electrical/Electronic
360
45
Landscaping
360
45
Painting
360
45
Ordinary Labor
280
35
Others
280
35
Total
E. IMPACT OF BRIGADA ESKWELA (Enrolment Rate) % of Increase/Decrease
Enrolment June 15, 2015 Minus Enrolment Year End March 2014-15 =

E. IMPACT OF BRIGADA ESKWELA (Enrolment Rate) % of Increase/Decrease

Enrolment June 15, 2015 Minus Enrolment Year End March 2014-15 =

F. SIGNIFICANT EVENTS / EXPERIENCES (Use separate sheets, if needed)

What happened?
Who were involved?
When?

What is/are its im

contribution to th
school or to the e
school?

G. ISSUES AND CONCERN (Describe briefly problems encountered and how resolve)

H. LESSON LEARNED / BEST PRACTICES

I. SUGGESTION TO STRENGTHEN BRIGADA ESKWELA PROGRAM

J. EVIDENCES / ATTACHMENTS
a. Photos (before, during and after
b. Photocopy of all completed BE forms:
1. Form 01 3. Form 03 5. Form 05
2. Form 02 3. Form 04 6. Form 06

J. EVIDENCES / ATTACHMENTS
a. Photos (before, during and after
b. Photocopy of all completed BE forms:
1. Form 01 3. Form 03 5. Form 05
2. Form 02 3. Form 04 6. Form 06

Prepered by:

____________________________________
Name of School Head with Signature

Date:

_________________
and
Designation

Submit this Report to Division Office on or before June 19, 2016 (Two (2) Folders)

___________

OL ID:

ACT NUMBER:
ACT NUMBER:
epEd Memo No. 41, s.
propriate column)
Replaced

Repaired

Repainted

ded)
Estimated Cost

Others

olunteers
Day
Day
3
4

ts, if needed)
Total Number
of Hours
Rendered

Day
5

Day
6

Total

Total Estimated
Costs

What is/are its important

contribution to the operation of the
school or to the existing needs of the
school?

solve)

ers)

Date:

___________________