LGUIA FORM 1.

PREPARE CY 2017

Assessment/Evaluation Form for PROJECT PREPARE

DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT

Region 02

2017 LGU Incentives and Awards (LGUIA)

PROJECT PREPARE
Popularizing and Recognizing Excellence in Preparedness And Resilience against Emerging disasters (PREPARE)

ASSESSMENT/EVALUATION FORM
(Province/City/1st-3rd Class Municipality/4th - 6th Class Municipality)

City/Municipality: _________________________________
Province: _________________________________________
Date of Assessment/Evaluation: _____________________

Instruction: Kindly answer the questions in this Form by ticking appropriate boxes and attach the means of verification. If
means of verification are not provided, positive responses may not be considered. You need to compile the required supporting
documents for verification.

ASSESSMENT CRITERIA YES PARTIAL NO

I. STRUCTURE
A. DRRM Council
1. DRRM Council organized
2. DRRM Council composed as follows:
a. LCE as Chair
b. LG Department Heads
c. Schools Division Superintendent, DepEd (For Provinces &
Cities)
District Supervisor, DepEd (For Municipaclities)

d. Highest Ranking Officer assigned in the area, AFP

e. Head, Local PNP
f. Head, Local BFP
g. Head, Local Liga ng mga Barangay
h. Representative, Philippine Red Cross
i. Four (4) Representatives, Accredited CSOs
j. Representative, Private Sector
3. DRRM Council functionality
a. Meetings conducted
b. Policies/Resolutions formulated/adopted
B. LDRRM Office
1. Local DRRM Office established with signage

2. DRRM Office equipped with communications facilites

3. Local DRRM Officer
appointed
designated
1
 ASSESSMENT CRITERIA YES PARTIAL NO
4. LDRRM Officer assisted by staff responsible for…
Administration and Training
Research and Planning
Operations and Warning
5. Organizational Chart posted
6. Action Plan formulated
7. Accomplishment report available
C. Operation Listo Team
1. Listo Team organized
2. Listo Team clustered into
a. Security, Lifeline, SRR (Cluster 1)
b. Humanitarian (Cluster 2)
c. Information and Awareness (Cluster 3)
3. Cluster 1 Team composed of
a. Search, Rescue and Retrieval Associates
b. Security Associates
c. Medical Associates
d. Clearing Operations Associates
4. Cluster 2 composed of
a. Evacuation Management Associates

b. Mass Feeding and Relief Distribution Associates

5. Cluster 3 composed of
a. Media Relations Associates
II. PLANS AND BUDGET
A. DRRM Plan
1. DRRM Plan formulated by LDRRMC and adopted by
Sanggunian

2. Activities in the Plan categorized into 4 thematic areas

3. DRRM Plan mainstreamed into:
CDP-CLUP- for Cities/Municipalities
PDPFP- for Provinces
B. Local Climate Change Action Plan (LCCAP)
1. LCCAP formulated and adopted
2. LCCAP based from Vulnerability & Adaptation /
Assessment (V&AA) results
3. LCCAP mainstreamed into:
CDP-CLUP- for Cities/Municipalities
PDPFP- for Provinces
C. Contingency Plan

1. Contingency Plan formulated and adopted

D. DRRM Fund Allocation and Utilization

1. 5% of total budget allocated for DRRM

2. 5% DRRM budget sub-allocated into 70% for /
Preparedness and 30% as Quick Response Fund

3. DRRM Fund utilized according to prescribed 70%-30% policy

4. DRRM Fund utilization posted in portal/conspicuous /

places
2
 ASSESSMENT CRITERIA YES PARTIAL NO
III. SYSTEMS
A. Disaster Protocols

1. Disaster Protocols (Alpha, Bravo, Charlie) adopted

B. Incident Command System (ICS)
1. ICS established and adopted
2. ICS Organizational Structure established

3. Roles and responsibilities of ICS responders delineated

C. Early Warning System (EWS)
1. EWS established and adopted
D. Evacuation System (EMS)
1. Evacuation Plan formulated and adopted
2. Evacuation Route identified

3. Local policy on forced or pre-emptive evacuation enacted

D. Response and Rehabilitation Systems

1. Relief operations system established and adopted

2. Peace and security system established and adopted

3. Medical and psychosocial support system established and /
adopted

4. Search, rescue and retrieval system established and adopted

5. Clearing operations system established and adopted

E. Reporting System
1. Reporting system established and adopted
2. Situational/progress report prepared and submitted to higher
DRRM Councils
IV. PROCESSES
A. Risk/ Vulnerability and Adaptation Assessment (V&AA)
1. Risk/V&AA activity conducted
2. Risk/V&AA Analysis prepared
3. Risk/V&AA Profile formulated
V. DATABASE AND MAPS
A. Data on elements at risk
1. Hazard prone barangays identified
2. Population and families at risk to hazards identified
3. Hazard prone/at risk infrastructures identifed
B. Maps
1. Hazard(s) map, available
2. Vulnerability map, available
VI. RESOURCES AND CAPACITIES
A. Manpower
1. Emergency Response Team (ERT) organized
2. ERT trained
3. Guide for ERT formulated and adopted
4. Simulation exercises conducted
B. Facilities

3
 ASSESSMENT CRITERIA YES PARTIAL NO
1. Disaster Operations Center established
2. Evacuation Center established

3. Evacuation Center complies with the following standards:

a. Permanent and disaster-resilient
b. Not in high-risk areas
c. Accessible
d. With toilets for men and women
e. With separate toilet for Persons With Disabilities
f. With power supply
g. With water supply
h. With generator sets
i. With assembly area for relief distribution
j. With community kitchen
k. Women & Children Friendly Space
l. Couples Room
4. Animals/Crops Relief Park established
5. Inventory of Facilities, available
C. Equipage
1. EWS devices, available
2. Search, Rescue and Retrieval devices/equipment, /
available
3. Equipment for clearing operations, available
4. Communication devices available
5. Fire Fighting equipment
- Fire Extinguisher (10 lbs)
- Fire Trucks
D. Supplies/Stockpile
1. First aid kits/medicines, available
2. Food items, available
3. Non-food items, available
E. Linkage

1. Directory/contact numbers of key local and national DRRM

officials, media, shool administrators and volunteers, available
2. Hotline/emergency numbers, available
VII. COMMUNITY AWARENESS
A. Advocacy
1. IEC Materials on DRRM posted/disseminated
2. Family Guide to Action formulated/adopted
3. Family Guide to Action disseminated
4. Orientation/fora/meetings conducted
VIII. PARTNERSHIP AND VOLUNTEERISM
A. Partnership with NGAs/LGUs/CSOs/PS/Business and other
stakeholders
1. Partnership on disaster preparedness forged

2. Partnership on disaster prevention and mitigation forged

3. Partnership on disaster response forged

4. Partnership on disaster rehabilitation and recovery forged

IX. INNOVATIONS/AWARDS

4
 ASSESSMENT CRITERIA YES PARTIAL NO
(Pls list Innovations and/or awards received by the LGU related to DRRM for
the last 3 years)

Evaluated by:

SIGNATURE OVER PRINTED NAME OF EVALUATOR

Position/Designation/Agency

Date Accomplished

5
 DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT
Region 02

2018 LGU Incentives and Awards (LGUIA)

PROJECT PREPARE

Popularizing and Recognizing Excellence in Preparedness and Resilience against Emerging

disasters

ASSESSMENT CRITERIA AND MEANS OF VERIFICATION

ASSESSMENT CRITERIA MEANS OF VERIFICATION

I. STRUCTURE
A. DRRM Council
1. DRRM Council organized Executive Order
2. DRRM Council composed as follows: Executive Order
a. LCE as Chair
b. LG Department Heads
c. Schools Division Superintendent, DepEd (For Provinces &
Cities)

District Supervisor, DepEd (For Municipaclities)

d. Highest Ranking Officer assigned in the area, AFP
e. Head, Local PNP
f. Head, Local BFP
g. Head, Local Liga ng mga Barangay

h. Representative, Philippine National Red Cross

i. Four (4) Representatives, Accredited CSOs

j. Representative, Private Sector
3. DRRM Council functionality

Minutes of meetings/attendance
sheets/pictorials
a. Meetings conducted
Copy of duly adopted
b. Policies/Resolutions formulated/adopted policies/resolutions
c. Action Plan formulated Copy of Action Plan
Copy of Accomplishment
d. Accomplishment report available report,pictorials
B. LDRRM Office
1. Local DRRM Office established Photo
Photos
2. DRRM Office equipped with communications facilites
3. Local DRRM Officer

6
 ASSESSMENT CRITERIA MEANS OF VERIFICATION

appointed Appointment Order

designated Designation Order
4. LDRRM Officer assisted by staff responsible for…

Appointment/Designation order
Administration and Training
Appointment/Designation order
Research and Planning

Appointment/Designation order
Operations and Warning
organizational chart/on-site
5. Organizational Chart posted
C. Operation Listo Team
1. Listo Team organized Executive Order
2. Listo Team clustered into
same Executive Order organizing
LISTO team
a. Security, Lifeline, SRR (Cluster 1)
same Executive Order organizing
b. Humanitarian (Cluster 2) LISTO team
same Executive Order organizing
c. Information and Awareness (Cluster 3) LISTO team
3. Cluster 1 Team composed of
same Executive Order organizing
a. Search, Rescue and Retrieval Associates LISTO team
same Executive Order organizing
b. Security Associates LISTO team
same Executive Order organizing
c. Medical Associates LISTO team

same Executive Order organizing

LISTO team
d. Clearing Operations Associates
4. Cluster 2 composed of
same Executive Order organizing
a. Evacuation Management Associates LISTO team
same Executive Order organizing
b. Mass Feeding and Relief Distribution Associates LISTO team
5. Cluster 3 composed of
same Executive Order organizing
a. Media Relations Associates LISTO team
II. PLANS AND BUDGET
A. DRRM Plan
Copy of Plan and Res/Ord. adopting
1. DRRM Plan duly approved and adopted the Plan
2. Activities in the Plan categorized into 4 thematic areas Copy of DRRM Plan
3. DRRM Plan mainstreamed into LGU CLUP-CDP Copy of CDP
B. Local Climate Change Action Plan (LCCAP)
Copy of Plan and Res/Ord. adopting
1. LCCAP formulated and adopted the Plan
2. LCCAP based from Vulnerability & Adaptation Copy of LCCAP and V&AA results
Assessment / (V&AA) results
3. LCCAP mainstreamed into LGU CLUP-CDP Copy of CDP
C. Contingency Plan
7
 ASSESSMENT CRITERIA MEANS OF VERIFICATION

1. Contingency Plan formulated and adopted Copy of Contingency Plan

D. Provincial Development Physical and Framework Plan
(PDPFP) for provinces
1. PDPFP available Copy of PDPF Plan
E. DRRM Fund Allocation and Utilization
1. 5% of total budget allocated for DRRM Annual Investment Plan

DRRM Plan
2. 5% DRRM budget sub-allocated into 70% for Preparedness /
and 30% as Quick Response Fund

Copy of fund utilization report and

photo of posting
3. DRRM Fund utilization posted in portal/conspicuous places
III. SYSTEMS
A. Disaster Protocols
Copy of Disaster Protocols (Alpha,
1. Disaster Protocols (Alpha, Charlie, Bravo) adopted Bravo, Charlie) posted
B. Incident Command System (ICS)
1. ICS established and adopted Copy of ICS document
2. ICS Organizational Structure established ICS document
3. Roles and responsibilities of ICS responders delineated ICS document
C. Early Warning System (EWS)
1. EWS established and adopted Copy of EWS mechanism
D. Evacuation System (EMS)
1. Evacuation Plan formulated and adopted Copy of Evacuation Plan

Copy of Evacuation Route map

2. Evacuation Route identified

Ordinance adopting the forced/pre-

emptive evacuation policy
3. Local policy on forced or pre-emptive evacuation enacted
D. Response and Rehabilitation Systems
system policy,documents
1. Relief operations system established and adopted
system policy
2.
3. Peace andand
Medical security system support
psychosocial established and established
system adopted and
adopted system policy

system policy
4. Search, rescue and retrieval system established and adopted
system policy
5. Clearing operations system established and adopted
E. Reporting System
Communications/Reporting flow
1. Reporting system established and adopted chart
2. Situational/progress report prepared and submitted to / Copy of reports, transmittals
higher DRRM Councils
IV. PROCESSES

A. Risk/ Vulnerability and Adaptation Assessment (V&AA)

1. Risk/V&AA activity conducted Activity report, pictorials
2. Risk/V&AA Analysis prepared Copy of Risk/V&AA Analysis

8
 ASSESSMENT CRITERIA MEANS OF VERIFICATION

3. Risk/V&AA Profile formulated Copy of Risk/V&AA Profile

V. DATABASE AND MAPS
A. Data on elements at risk
List of hazard prone barangays,
1. Hazard prone barangays identified various plans
List of population and families at risk,
2. Population and families at risk to hazards identified various plans
List of vulnerable or marginalized individuals,
3. Vulnerable or marginalized individuals identified various plans
B. Maps
1. Hazard(s) map, available Copy of hazard map
2. Vulnerability map, available Copy of vulnerability map
VI. RESOURCES AND CAPACITIES
A. Manpower
1. Emergency Response Team (ERT) organized Executive orcder
Activity/Training report and photos
2. ERT trained
3. Guide for ERT formulated and adopted Copy of Guide for ERT
4. Simulation exercises conducted Activity report and photos
B. Facilities
Photo of Disaster Operations center,
1. Disaster Operations Center established on-site visit
Photo of Evacuation center, on-site
2. Evacuation Center established visit

3. Evacuation Center complies with the following standards:

a. Permanent and disaster-resilient Photo, on-site visit
Refer to hazard/vulnerability map,
b. Not in high-risk areas on-site visit
c. Accessible Refer to LGU map, on-site visit
d. With toilets for men and women Photo, on-site visit
e. With separate toilet for Persons With Disabilities (PWDs) Photo, on-site visit
f. With power supply Photo, on-site visit
g. With water supply Photo, on-site visit
h. With generator sets Photo, on-site visit
i. With assembly area for relief distribution Photo, on-site visit
j. With community kitchen Photo, on-site visit
k. Women & Children Friendly Space Photo, on-site visit
l. Couples Room Photo, on-site visit
4. Animals/Crops Relief Park established Photo, on-site visit
C. Equipage
Photos, Inventory report/MR, on-site
1. EWS devices, available visit
Photos, Inventory report/MR, on-site
2. Search, Rescue and Retrieval devices/equipment, available visit
3. Equipment for clearing operations, available Photos
4. Communication devices available Photos
5. Fire Fighting equipment Photos, MOU, On-site
- Fire Extinguisher (10 lbs) Photos, MOU, On-site
- Fire Trucks Photos, MOU, On-site

9
 ASSESSMENT CRITERIA MEANS OF VERIFICATION

D. Supplies/Stockpile
1. First aid kits/medicines, available Photos, MOU, On-site
2. Food items, available Photos, MOU, On-site
3. Non-food items, available Photos, MOU, On-site
E. Linkage

Copy of directory, e-copies/sytems-

1. Directory/contact numbers of key local and national /
based
DRRM officials, media, shool administrators and volunteers,
available
VII. COMMUNITY AWARENESS
A. Advocacy
Copy of IEC Materials Photos of
1. IEC Materials on DRRM posted/disseminated posting
Copy of Family Guide to Action
2. Family Guide to Action formulated/adopted
Details of dissemination (Activity,
3. Family Guide to Action disseminated date, photos)
4. Orientation/fora/meetings conducted Activity report and photos
VIII. PARTNERSHIP AND VOLUNTEERISM
A. Partnership with NGAs/LGUs/CSOs/PS/Business and /
other stakeholders
MOA/MOU/Plege of Commitment
1. Partnership on disaster preparedness forged

MOA/MOU/Plege of Commitment
2. Partnership on disaster prevention and mitigation forged
MOA/MOU/Plege of Commitment
3. Partnership on disaster response forged

MOA/MOU/Plege of Commitment
4. Partnership on disaster rehabilitation and recovery forged
IX. INNOVATIONS/AWARDS
(Pls list Innovations and/or awards received by the LGU related to DRRM)
Supporting documents/Certificate of
Recognition/Citations

10
LGUIA FORM 2.2.BT Team CY 2018
Assessment/Evaluation Form for Outstanding BT (Team Community Service)

DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT

Region 02

2018 LGU Incentives and Awards (LGUIA)

SEARCH FOR OUTSTANDING BARANGAY TANOD
TEAM COMMUNITY SERVICE

ASSESSMENT/EVALUATION FORM

Barangay: _____________________ Date of Assessment/Evaluation: ____________

City/Mun:_____________________
Province:______________________

POINT SCORE
CRITERIA Total Point
Assigned Score Granted Score
Score
A.      ADMINISTRATIVE REQUIREMENTS 10

1.       Presence of Brgy. Resolution/Ordinance/EO

organizing BT as Community Brigade pursuant to 3
Chapter 2, Sec. 387 of the LG Code of 1991

2.       Barangay Tanods duly recommended by

3
Sangguniang Barangay
3.       Issuance of appropriate appointment 4
B. FUNCTIONALITY 30

1.       Barangay Tanod Organizational Structure/Chart

3
Posted in the Barangay Hall

2.       Organizations of Barangay Tanod into teams and

Designated as Officers of the Day with Posted 3
Schedule

3.       Schedule of Barangay Tanod as Officers of the

3
Day posted in the Barangay Hall.

4.       Presence of Office Space for Barangay Tanods in

3
the Barangay Hall

5.       Presence of Temporary Custodial Cell or other

1
Structures Used by Barangay Tanod

6.       Presence of gadgets and paraphernalia:

-          Uniform (maong pants, white T-shirt, vest with

2
markings and name, ball cap and rubber shoes)

11
 POINT SCORE
CRITERIA Total Point
Assigned Score Granted Score
Score
-          Night Stick with teargas (baton) 2
-          Handcuff with Holster 2
-          Whistle and Flashlight 2
-          Raincoat and Boots 2

-          Small Notebook and ballpen 1

-          First Aid Kit 2

7.       Available Equipments, Motor/Services Vehicles,

Bikes, Computers, Typewriters, Etc. Owned by the 4
Barangay
C.      SUSTAINABILITY 10
1.       Inclusion/Integration of the BT budget in the
6
2017 and 2018 Annual Budget
a.       Below Php 10,000.00 1.5
b.      Between Php 10,000 to P25,000 3
c.       Between Php 25,000 to P100,000 4.5
d.      More than Php 100,000 6
2. Training attended (pls. specify by type) 4
a. National level 1

b. Regional Level 1
c. Provincial Level 1

d. City/Municipal Level 1

D. ACCOMPLISHMENTS 50
MAJOR ACCOMPLISHMENTS 30
Apprehensions, Acting as Tipster of major crime
Anti-criminality Efforts 10
Thwarting/Foiling of Robbery Acts 10
Other Law Enforcement accomplishments 10
Please specify:
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________

MINOR ACCOMPLISHMENTS 20
Assistance Task (VAWC, KP, Traffic, Checkpoint, 2
Fiesta, Burial)
Ronda/ Foot Patrol 2
Disaster Operations (Rescue and Relief) 11
- Assistance to other barangay (s)
5
Other Law Enforcement minor accomplishments
Please specify:
___________________________________

12
 POINT SCORE
CRITERIA Total Point
Assigned Score Granted Score
Score
___________________________________
___________________________________
___________________________________

*Minor Accomplishments shall be given 5 points

each

TOTAL SCORE 100

Evaluated by:

SIGNATURE OVER PRINTED NAME OF EVALUATOR

Position/Designation/Agency

Date Accomplished

13
LGUIA FORM 2.1. BT INDIVIDUAL CY 2018
Assessment/Evaluation Form for Outstanding BT (Individual Community Service)

DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT

Region 02

2018 LGU Incentives and Awards (LGUIA)

SEARCH FOR OUTSTANDING BARANGAY TANOD

INDIVIDUAL COMMUNITY SERVICE

ASSESSMENT/EVALUATION FORM

Barangay: _____________________ Date of Assessment/Evaluation: ____________

City/Mun:_____________________
Province:______________________

POINT SCORE
Total Point
CRITERIA Assigned Score Granted Score
Score
A.      LENGTH OF SERVICE 10

-          Above 10 years 10

7-9 Years 8
4-6 Years 6
1-3 Years 4

B.      AWARDS/CITATIONS 20

1.       Regional Level 20

2.       Provincial Level 16
3.       City/Municipal Level 12
4.       Barangay Level 8

C. TRAININGS/ SEMINARS ATTENDED 10

(for the last 3 Years)
1. National Level 10
2.       Regional Level 8
3.       Provincial Level 6
4.       City/Municipal Level 4

D. ACCOMPLISHMENTS 60
MAJOR ACCOMPLISHMENTS 30
Acting as Tipster of major crime 12.5
Anti-criminality Efforts 12.5

14
 POINT SCORE
Total Point
CRITERIA Assigned Score Granted Score
Score
Other Law Enforcement accomplishments 5
Please specify:
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________

*Major Accomplishments shall be given 10 points

each

MINOR ACCOMPLISHMENTS 30
Assistance Task (Traffic outside schools and other 5
related activities)
Ronda-Depending on Frequency 10
Disaster and Relief Operations 10
5
Other Law Enforcement minor accomplishments
Please specify:
___________________________________
___________________________________
___________________________________
___________________________________

*Minor Accomplishments shall be given 5 points

each

TOTAL SCORE 100

Evaluated by:

SIGNATURE OVER PRINTED NAME OF EVALUATOR Date Accomplished

Position/Designation/Agency

15
LGUIA FORM 3. Barangay Peace and Order Committee CY 2018
Assessment/Evaluation Form for Outstanding BPOC

DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT

Region 02

SEARCH FOR OUTSTANDING

BARANGAY PEACE AND ORDER COMMITTEE

ASSESSMENT/EVALUATION FORM

Barangay: _____________________ Date of Assessment/Evaluation: ____________

City/Mun:_____________________
Province:______________________

POINT SCORE
CRITERIA Total Point Granted
Assigned Score
Score Score
A. ORGANIZATION 10
1. Constituted Through a Resolution/Executive 3
Order
3
2. Conformed with prescribed membership
3. BPOC members briefed of their roles and 4
functions
B. MEETINGS 10

1. Number of Minutes of Meetings duly signed by

4
the BPOC Secretariat and BPOC Chair

- 4 meetings 4
- 3 meetings 3
- 2 meetings 2
- 1 meeting 1

2. Attendance to meetings of mandatory members 3

3. Special attendees of BPOC meetings and other

3
Government Agencies

3. POLICIES, PLANS AND BUDGET 30

1. Presence of policies (resolutions and agreement)

10
relevant to the problems discussed

2. Barangay Annual Public Safety Plan (BPSP)

developed/enhanced & 10
updated

16
 POINT SCORE
CRITERIA Total Point Granted
Assigned Score
Score Score
3. BPSP were funded in the annual budget 5

4. BPSP with budget from outside sources 5

4. ACCOMPLISHMENTS REPORT 50
1. Percentage of PPA Implementation 15
91% - 100% 15
81% - 90% 13
71% - 80% 11
61% - 70% 9
51% - 60% 7
50% below 5
2. Fund Utilization 15
91% - 100% 15
81% - 90% 13
71% - 80% 11
61% - 70% 9
51% - 60% 7
50% below 5
10
3. Number of reports submitted to C/MPOC or PNP
4 10
3 8
2 6
1 4

4. Number of activities participated by citizens and 10

civic organizations
4 10
3 8
2 6
1 4
5. Other Awards and Citations Received - Bonus
3
Points
a. Regional Level 3
b. Provincial Level 2
c. City/Municipal 1
TOTAL 100

Evaluated by:

SIGNATURE OVER PRINTED NAME OF EVALUATOR Date Accomplished

Position/Designation/Agency

17
LGUIA FORM 5. LTIA CY 2018

Assessment/Evaluation Form for LTIA

DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT

Region 02

2018 LUPONG TAGAPAMAYAPA INCENTIVES AND AWARDS (LTIA)

ASSESSMENT/EVALUATION FORM

Lupon : _______________________________________ City/Mun : ______________________________

Category: ____________________________________ Province:_______________________________
Date of Assessment/Evaluation:____________________

ASSIGNED SCORE REMARKS/

CRITERIA POINT POINT TABLE OBSERVATIONS
ON-SITE
SCORE VALUE ASSESSMENT
1. EFFICIENCY IN OPERATION
A. Observance of Settlement Procedures and Deadlines
Settlement Procedures 10
proper recording of complaints 4
serving of summons to parties 4
observance of the prescribed period in the settlement dispute 2
Settlement Deadlines 5
within 15 days after filing of complaints 5
within 30 days 4
within 45 days 3
46 days and above 2
To compute: cases settled x assigned point score = Score
total number of cases filed

Actual Illustration:
18
 ASSIGNED SCORE REMARKS/
CRITERIA POINT POINT TABLE OBSERVATIONS
ON-SITE
SCORE VALUE ASSESSMENT

Actual Illustration:
Total Number of Cases 18
Meditated Cases 18
Conciliated Cases 0
Arbitrated Cases 0

Meidated Cases : 18x5

18
Conciliated Cases: 0

Arbitrated Cases: 0

Total Score: 5 + 0 + 0 = 5

B. Systematic Maintenance of Records 5

Records of complaints filed, settled 2
Records of minutes of meetings filed 1.5
Transmittal of reports to DILG, Court, etc 1.5
Note: How KP recrods are maintained should be explained briefly.
A photo of the filing system showing the above documents is also
acceptable
C. Timely Submission of Reports to Concerned Agencies 5

To Court: Number of reports submitted on time x 2.5

12 months 2.5

To DILG: Number of reports submitted on time x 2.5

12 months
2.5

Supporting Documents: copies of complete transmittals to

concerned agencies to generate full score
D. Conduct of Monthly Meetings Exclusively on KP Matters 10
To compute the point value: 8x10/12 = 6.66
number of reported KP meetings x 10
required no. of meetings covering the period (12)
supporting documents: copies of minutes of meetings
Note: Meetings wherein majority of the Agenda are on KP is rated
a maximum of 10 points. Meetings that are not KP concerns will be

19
 ASSIGNED SCORE REMARKS/
CRITERIA POINT POINT TABLE OBSERVATIONS
ON-SITE
SCORE VALUE ASSESSMENT
deducted from the total number of meetings reported
2. Effectiveness in Securing the Objective of the KP Program
A. Quantity of settled cases against filed 10
90-100% 10
80-89% 8
70-79% 6
60-69% 4
59% below 2
Note: Dismissed or withdrawn cases cannot be considered as settled
unless there is an agreeement between parties to withdraw as indicated
by action taken either through mediation of conciliation.
B. Quality of Settlement of Cases 5
Zero case repudiated
0 5
1-2 4
3 3
more than 3 2
Non-recurrence of cases settled 5
0 5
1-2% 4
3% 3
more than 3% 2
C. At least 80% compliance with the terms of settlement after the cases
have been settled 10
80-100% (with supporting documents) 10
70-79%(with supporting documents) 8
60-69%(with supporting documents) 6
50-51%(with supporting documents) 4
49% and below(with supporting documents) 2
Note: a reduction of 5 points in the corresponding score of the lupon,
if report is not supported by document, i.e., sample of payment
if cases involved collection of money or dates of compliance.
Without report on terms of compliance is rated zero.
3. Creativity and Resourcefulness of the Lupong Tagapamayapa

20
 ASSIGNED SCORE REMARKS/
CRITERIA POINT POINT TABLE OBSERVATIONS
ON-SITE
SCORE VALUE ASSESSMENT
A. Settlement Technique 5
Reported more than one innovations 5
(newly introduced methods never before utilied by other lupons)
Reported one innovative method 4
Reported methods already utilized by other lupons or already 3
reported in previous year
Traditional methods that were reported as innovative methods 2
No report 0
B. Proper Coordination with Concerned Agencies 5
Report of Coordination with document 5
Report of Coordination without document 2.5
No report of Coordination 0
Supporting Documents: Pictures or date when coordinaion visit was
made to concerned agency/ies
C. Sustained Advocacy Efforts in the Promotion of KP Objectives 5
With report and proof of advocacy efforts, i.e. photo and activity design 5
With report but without proof 2.5
No report of any advocacy effort 0
D. KP Trainings or Seminars within the Assessment Period 10
either the barangay, municipality, city or province within the
assessment period
Reported more than one training or seminar with supporting documents 10
Reported one training or seminar with supporting documents 6
Reported training or seminar but no supporting documents 4
No report of any training initiated 0
Supporting Document: picture or date and venue of training
4. Area or Facility for KP Activities 5
Report of a building or room for KP with supporting document 5
Report of a space for KP with supporting document 4
With report but no supporting document 2.5
Without report 0
5. Financial or Non-Financial Support 5

21
 ASSIGNED SCORE REMARKS/
CRITERIA POINT POINT TABLE OBSERVATIONS
ON-SITE
SCORE VALUE ASSESSMENT
Report on Mobilization of support and with supporting documents 5
Report on Mobilization of support wihtout supporting document 2.5
No report of any mobilization of support from the above-mentioned 0
entities
TOTAL SCORE 100

Evaluated by:

____________________________________________ ____________________________ __________________

SIGNATURE OVER PRINTED NAME OF EVALUATOR Position/Designation/Agency Date Accomplished

22
LGUIA FORM 6.BESTS CY 2018

Assessment/Evaluation Form for Outstanding BESTS

DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT

Region 02

SEARCH FOR MOST OUTSTANDING BARANGAY, BARANGAY EXECUTIVE,

SANGGUNIANG BARANGAY, TREASURER AND SECRETARY (BESTS)

ASSESSMENT/EVALUATION FORM

Barangay: ____________________________ Date of Assessment/Evaluation : ___________________

City/Municipality:_______________________

MAXIMUM ACTUAL
CRITERIA
SCORE SCORE

I. ADMINISTRATION 52.0%

1.ADMINISTRATIVE SUPPORT SYSTEMS 16.5%

1.1. Barangay Hall 1.0

23
 MAXIMUM ACTUAL
CRITERIA
SCORE SCORE

· Barangay-owned structure and lot 1.0         

· Privately-owned structure 0.5
1.2. Vision/Mission Statement 0.5
1.3 Updated Organizational Structure with pictures of Barangay Officials 1.0
indicating their respective committee chairmanship
1.4 Barangay Map 0.5
1.5 Barangay Socio-Economic Profile 1.0
1.6.Visible signages or signboards 0.5
1.7. Pictures of PresentPolitical Leaders 0.5
1.8. Presence of labeled tables and chairs for all Barangay Officials (PB, Sec, Treas, SBMs) 0.5
· Complete 0.5
· Incomplete 0.3
1.9. Functional and potable water system 1.0
1.10. Good lighting facilities 0.5
1.11. Good ventilation 0.5
1.12. Presence of equipment/ facilities (computers/typewriter, filing cabinets) 1.0
1.13. Presence of receiving/ waiting area for clients with convenient fixtures 1.0
1.14. Clean Comfort Rooms/Restroom 0.5
1.15. Presence of Bulletin Board for posting/disclosure of pertinent documents 1.0
1.16. Updated barangay Citizen's Charter/Information Billboard 1.0
1.17. Presence of Violence Against Women and Children Desk Officer 1.0
1.18. Presence of Volunteer Workers 2.5
· Health Workers 0.5
· Barangay Tanods 0.5
· Day-Care Workers 0.5

24
 MAXIMUM ACTUAL
CRITERIA
SCORE SCORE

· Barangay Nutrition Scholars 0.5

· Midwives 0.5
1.19. Well-maintained street lights 1.0
2. TRANSPARENCY AND ACCOUNTABILITY 13%
2.1 Public Assistance and Complaint Desk 2.0
· EO Designating a Desk Officer/Officer of the Day 1.0
· Logbook 0.5
· Schedule of Officer of the Day 0.5
2.2 Full Disclosure Policy 6.0
· Posting of Barangay Annual Budget (2018) (full pt: approved or draft) 1.0
· Posting of Monthly Collections and Disbursements (Jan-June 2017) 1.0
· Posting of Summary of Income and Expenditures (2017) 1.0
· Posting of the 20% of the IRA Utilization (Jan-June 2018) 1.0
· Posting of Annual Procurement Plan or Procurement List (2018) 1.0
· Posting of List of Notices of Award (1st Qtr 2018 docs) 1.0
2.3 Synchronized Barangay Assembly Day 3.5
· Schedules:
- Second Semester, CY 2017 (October) 0.75
- First Semester, CY 2018 (March) 0.75
· SBAD Report for October, 2017 0.25
· Minutes of Meeting for October, 2017 0.50
· Attendance Sheet for October, 2017 0.25
· SBAD Report for March, 2018 0.25
· Minutes of Meeting for March, 2018 0.50
· Attendance Sheet for March, 2018 0.25

25
 MAXIMUM ACTUAL
CRITERIA
SCORE SCORE

2.4 Conduct of Public Hearings/Attendance to Public Hearings 0.5

2.5 CSOs/POs Mandatory Membership of 1/4 of total membership to councils 1.0
- BDC 0.50
- BPOC 0.50
3. BASIC SERVICES AND FACILITIES 22.5%
3.1. SOCIAL 7.0
· Presence of functional Katarungang Pambarangay 1.0
· Presence of Health/Hygiene Programs (2017)
- Supplemental Feeding for Malnourished Children 0.3
- Immunization Program 0.3
- Operation Timbang 0.3
- Micronutrient supplementation 0.3
- Child and Maternal Care 0.3
- Deworming Program 0.3
- Distribution of water- sealed toilet bowls 0.3
- Health Center 0.4
· Barangay Disaster Risk Reduction Management Operations Center 0.7
· Day Care Center 0.4
· Plaza/Park/Recreation Area/Basketball Court 0.3
· Barangay Patrol Vehicles (vehicle/motorbike/bicycle) 0.4
· Tanod Office/Outpost (within or outside barangay hall) 0.3
· Barangay Tanod Ronda/Foot Patrol 0.3
· Sports/Cultural Activities 0.3
· Water Supply System 0.4
· Multi-purpose Hall/Sports Center 0.4
26
 MAXIMUM ACTUAL
CRITERIA
SCORE SCORE

3.2. ECONOMIC 4.0

· Agricultural Support Services 1.0
- Distribution of seeds/seedlings 0.5
- Multi-purpose/drying pavement 0.5
· Seedling Nursery 1.0
· Livelihood Programs 2.0
3.3. ENVIRONMENTAL 3.5
· Presence of waste receptacles (barangay hall) 0.5
· Waste segregation at source (barangay hall) 0.5
· Solid waste management plan 0.5
· Tree planting 0.5
· Greening and beautification 0.5
· Clean-up drives 0.5
· Materials Recovery Facility (MRF) 0.5
3.4. PEACE AND ORDER 4.0
· Functional Barangay Anti-Drug Abuse Council (BADAC) 1.8
a. Structure 0.2
b. Budget 0.2
c. Policies/Issuances 0.2
d. Action Plan 0.2
e. Accomplishments 1.0
e.1. Conduct of regular meetings 0.5
e.2. Conduct of of IEC on illegal drug demand reduction 0.5

· Functional Barangay Peace and Order Council (BPOC) 1.2

27
 MAXIMUM ACTUAL
CRITERIA
SCORE SCORE

· Presence of plan to improve peace and order and public safety in the barangay 1.0

II. RECORDS MANAGEMENT AND FILING SYSTEM 14.5%

1 Properly labeled and alphabetically arranged files 1.0
2 Presence of Filing Cabinets 0.5
3 201 Files of Barangay Officials and Employees 0.5
4 Records of Leave Application 0.2
5 Statement of Assets, Liabilities and Networth 0.5
6 Oath of office of elective and appointive barangay officials and employees 0.5
7 Appointments of Barangay Officials and Employees 0.5
8 Updated Registry of Barangay Inhabitants 1.0
9 List/ Composition of the Barangay Assembly 1.0
10 List/ Composition of Barangay-Based Institutions including NGOs/POs
Participation 2.7
· NGOs/POs 0.3
· BDC 0.3
· BDRRMC 0.3
· LT 0.3
· BPOC 0.3
· BNC 0.3
· BCPC 0.3
· BAC 0.3
· BADAC 0.3
11 Copies of Designation/Appointments of the following: 2.4
· PACD Officer 0.4

28
 MAXIMUM ACTUAL
CRITERIA
SCORE SCORE

· VAWC Desk Officer 0.4

· Barangay Health Worker 0.4
· Barangay Nutrition Scholar 0.4
· Day-Care Workers 0.4
· Barangay Tanods 0.4
12 List of Precincts and Registered Voters 1.0
13 Files of Inventory of Barangay Properties and Facilities 0.8
14 Files of Local and National Issuances 0.2
15 Records/ Directory of NGOs/POs operating in the barangay 0.2
16 Presence of State of Barangay Governance Report (SBGR) ( PY 2017) 0.5
17 Files of Minutes of Sessions 0.5
18 Files of Ordinances and Resolutions 0.5
III. BARANGAY LEGISLATION 15.5%
1. Adopted Internal Rules of Procedure 2.0
4. No. of Regular & Special Sessions conducted (July 2017 - June 2018) 2.0
14 - above 2.0
9-13 1.0
1-8 0.5
5. Number of Ordinances enacted
4.0
5-above 4.0
3-4 3.0
1-2 2.0
6. Number of Resolutions Passed 4.0

29
 MAXIMUM ACTUAL
CRITERIA
SCORE SCORE

7-9 4.0
4-6 3.0
1-3 2.0
8. Presence of Session Hall 1.0
9. Orderly arranged tables and chairs with name tags for all Sanggunian Members 1.0
10. Best Practices / Innovations on Barangay Legislation 1.5
e.g. Tracking System
IV. FISCAL MANAGEMENT 17.5%
1. Duly Approved Barangay Development Plan (2018) 0.5
2. Duly Approved Barangay. Budget (2018) 0.5
3. Duly approved Annual Investment Program (2018) 0.5
4. Annual Procurement Plan (2018) 0.5
5. Books of Account (General and Trust Funds) 0.5
6. Financial Statements 0.5
7. Trial Balance 0.5
8. File of Summary of Collections and Deposits 0.5
9. File of Summary of Collections and Remittance 0.5
10. File of Debit/Credit Advances 0.5
11. File of Disbursement Vouchers 0.5
12. File of Cash Receipts and Deposits Register 0.5
13. File of Paid Checks/Bank Statement 0.5
14. File of Daily Statement of Collections and Accountable Forms 0.5
15. File of Summary of Paid Petty Cash Vouchers 0.5
16. File of summary of Cash Payments 0.5
17. Cash Disbursement Register 0.5

30
 MAXIMUM ACTUAL
CRITERIA
SCORE SCORE

18. Check Disbursement Register 0.5

19. File of Summary of Checks Issued 0.5
20. Monthly Report of Accountable Forms 0.5
21. File of Cash on Hand and In Bank Register 0.5
22. File of Property Acknowledgement Receipts (formerly Memorandum Receipts) 0.5
23. File of Status of Appropriations 0.5
24. Supplies Logbook 0.5
25. Certificate of Turnover of Projects/Records 0.5
26. Percentage of Fund generated from local source 1.0
as against IRA (Amount of locally generated / IRA X 100)
26% - above 1.0
21-25% 0.8
16-20% 0.6
11-15% 0.4
'5-10% 0.2
28. Fund Utilization (Local and IRA) (2017) 1.0
28.1 List of projects and services implemented during the year under
review with corresponding cost
29. BAC Meetings 1.0
29.1 Minutes 0.5
29.2 Items to Bid were posted 0.5
30. Project Documents (barangay implemented) 1.0
31. Fiscal Administration Best Practices/Innovations 1.0
(ex. Fund Sourcing)
_________________________________________________________

31
 MAXIMUM ACTUAL
CRITERIA
SCORE SCORE

_________________________________________________________
TOTAL 100%

Evaluated by:

_____________________________________________ ____________________________ __________________

SIGNATURE OVER PRINTED NAME OF EVALUATOR Position/Designation/Agency Date Accomplished

32
LGUIA FORM 4. CPOC/MPOC CY 2018

Assessment/Evaluation Form for City and Municipal POC

DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT

Region 02

SEARCH FOR OUTSTANDING

CITY/MUNICIPAL PEACE AND ORDER COUNCIL

ASSESSMENT/EVALUATION FORM
(Province/City/Municipality)
City/Mun:_____________________ Date of Assessment: __________
Province:______________________
POINT SCORE
CRITERIA
Total Point Score Assigned Score Granted Score

A. ORGANIZATION 10
1. POC constituted through Executive Order 2
2. No. of Agencies/Sectors Represented as
Members
16 or more 4
12-15 3
8-11 2
4-7 1
3. Exeutive Order/POC Resolution Confirming the
CSOs 2
4.EO /POC Resolution Creating the POPS TWG
and Special Action Teams 2
B. MEETINGS (CY 2017 to 1st Quarter 2018)
15
1. EO/POC Resolution Scheduling the Quarterly and
Special Meetings 3
2. Copy of Notices of Meetings With Agenda
5 or more Meetings 4
4 Meetings 3
2-3 Meetings 2
1 Meeting 1
3. Copies of Minutes of Meetings duly certified by
the Head Seretariat and Attested by the Chair

5 or more Meetings 4
4 Meetings 3
2-3 Meetings 2
1 Meeting 1
4. Copies of Attendance Sheets Certified Correct by
the Head Seretariat
5 or more Meetings 4
4 Meetings 3
2-3 Meetings 2
1 Meeting 1
C. POLICIES,PLAN AND BUDGET 20
1. 3-Year POPS Plan 5
2. POC Resolution Approving the POPS Plan 5
3. Approved POC Annual Implementation Plan for
CY 2017 5
4. Number of Resolutions Passed
10 or more Resolutions 5
7-9 Resolutions 3.75
4-6 Resolutions 2.5
 1-3 Resolutions 1.25
D. REPORTS AND ACCOMPLISHMENTS 50
1. Submission of POC Quarterly Reports to Higher
Level POCC (Based on Receiving Copy) CY 2017
to 1st Quarter 2018 (4 Quarterly, 2 Semi- Annual
and 1 Annual Reports = 7)
10
4 or More Reports Submitted 10
3 Reports Submitted 7.5
2 Reports Submitted 5
1 Report Submitted 2.5
2. Physical Accomplishment of Targets 15
90% - 100% of Targets Accomplished 15
80% - 89% of Targets Accomplished 12
70% - 79% of Targets Accomplished 9
60% - 69% of Targets Accomplished 6
50% - 59% of Targets Accomplished 3
3. Financial Accomplishment of Targets 15
90% - 100% of Targets Accomplished 15
80% - 89% of Targets Accomplished 12
70% - 79% of Targets Accomplished 9
60% - 69% of Targets Accomplished 6
50% - 59% of Targets Accomplished 3
4. Presence of an ordinance/resolution/similar
issuances in the promotion of peace and order in
the locality 5
a. Anti-Smoking 1
b. Liquor Ban 1
c. Firecracker/Pyrotechnic devices 1
d. Curfew 1
e. Others (specify) 1
_________________________
_________________________
E. INNOVATIONS 5
Good practices or activities of the POC supported
with Pictures, AVP and Post-Activity Reports.
10 or more Activities 5
7-9 Activities 3.75
4-6 Activities 2.5
1-3 Activities 1.25
F. AWARDS AND CITATIONS (BONUS)
National Level (1.5 Points each)
Regional Level (1 Point each)
Provincial Level (.5 Point each)
*Note: Aggregate Total Should Not be More Than 5 Points

TOTAL 100 100

Evaluated by:

SIGNATURE OVER PRINTED NAME OF EVALUATOR Date Accomplished

Position/Designation/Agency