SGLGB Form No.

SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY

Assessment Period: CY 2018
Data Capture Form

Identifying Information

Region : _______________________________
Barangay : _______________________________
City/Municipality: _______________________________
Province : _______________________________

CORE AREA 1: PEACE AND ORDER

INDICATORS DATA DATA SOURCE HOW TO DETERMINE ASSIGNED PASSING SCORE DOCUMENT
REQUIREMENTS THE SCORE SCORE SCORE OBTAINED SUBMITTED
BY THE
BARANGAY
1. Functionality of the Functionality of BADAC Barangay Secretary If the result is: 8 4
Barangay Anti-Drug Abuse based on DILG-DDB JMC  High = 8
Council (BADAC) No. 2018-01 and DILG DILG  Moderate = 4
MC No. 2018-135 City/Municipal  Low = 2
Office  No data = 0

2. Functionality of the BPOC Monitoring Form 2 DILG If the result is: 5 4

Barangay Peace and Order based on DILG MC No. City/Municipal  Ideal = 5
Committee (BPOC) 2008-101 Office  Mature = 4
 Progressive = 3
 Basic = 2
 BPOC organized = 1
 No BPOC= 0
 No data = 0
3. Performance Rate in the LTIA Form 003 based on DILG If the result is: 6 4
Lupong Tagapamayapa DILG MC No. 2016-58 City/Municipal  95-100 = 6
Incentives Awards (LTIA) Office  90-94 = 5
 85-89 = 4
 80-84 = 3
 75-79 = 2
 Below 75 = 1
 No data = 0
4. Maintenance of Record of RBI or similar system Barangay Secretary  With RBI = 1 1 1
Barangay Inhabitants Date of last update:  Without RBI = 0
(RBI) _______

TOTAL 20 13

CORE AREA 2: FINANCIAL ADMINISTRATION

INDICATORS DATA DATA SOURCE HOW TO DETERMINE PERFECT PASSING SCORE DOCUMENT
REQUIREMENTS THE SCORE SCORE SCORE OBTAINED SUBMITTED
BY THE
BARANGAY
1. Compliance with the BFDP Monitoring Form 1 DILG Presence of BFDP Board 4 4
Barangay Full Disclosure and Form 2 pursuant to City/Municipal  Yes = 4
Policy (BFDP) DILG MC No. 2014-81 Office  No = 0
Onsite Inspection Compliance to the design 3 3
CY 2018, 4th Qtr pursuant to Annex 8 of the
compliance: DILG MC No. 2014-81:
_____________________  Yes = 3
_  No = 0
If the result of CY 2018, 8 6
Location of the BFD 4th Qtr compliance is:
Board:  Full Compliance = 8
_____________________  Partial Compliance:
_ o 7 financial documents
posted = 7
o 5-6 financial
documents posted = 6
o 3-4 financial
documents posted = 4
o 1-2 financial
documents posted = 2
 Non-compliance = 0
 No data = 0
2. Percentage Increase in Barangay Budget Barangay Treasurer With increase? 5 5
local resources Preparation Form No. 2:  Yes = 5
Actual Income and  No = 0
Expenditure
City/Municipal
Total amount collected Accountant
from fees and charges:

CY 2017 PhP ________

CY 2018 PhP ________

Difference : PhP
_________
 Percentage increase: _____
TOTAL 20 18

CORE AREA 3: DISASTER PREPAREDNESS

INDICATORS DATA DATA SOURCE HOW TO DETERMINE ASSIGNED PASSING SCORE DOCUMENT
REQUIREMENTS THE SCORE SCORE SCORE OBTAINED SUBMITTED
BY THE
BARANGAY
1. Functionality of the 5% BDRRM Fund in the Barangay Secretary/ With at least 5% BDRRM 2 2
Barangay Disaster Risk Barangay : PhP Barangay Treasurer Fund allocation
Reduction and __________  Yes = 2
Management Committee  No = 0
(BDRRMC)
EO or similar issuance Local Disaster Risk BDRRMC supported with 1
creating the BDRRMC Reduction and EO or similar issuance 1
Management  Yes = 1
Officer (LDRRMO)  No = 0
 No data = 0

Approved BDRRM Plan With Approved BDRRM 2 1

Plan
Approved plan using the  Yes, using the prescribed
prescribed template template = 2
(LISTO)  Yes, not using the
prescribed template = 1
 No = 0
Minutes of the quarterly Conduct of quarterly 2
meeting meeting
 4 out of 4 = 2 1
 2 or 3 out of 4 = 1
 1 out of 4 = 0
 No = 0
 No data = 0
Utilization Report Utilization of the 70% 1
BDRRM Fund 1
 50% and above = 1
 Less than 50% = 0.5
 No = 0
 No data = 0

6. Accomplishment rate of  Approved BDRRM Barangay Secretary Rate of Accomplishment: 3 2

the activities/projects Plan  60% and above = 3
reflected in the Barangay  Accomplishment Local Disaster Risk  40 – 59% = 2
Disaster Risk Reduction Report Reduction and  20 – 39% = 1
 INDICATORS DATA DATA SOURCE HOW TO DETERMINE ASSIGNED PASSING SCORE DOCUMENT
REQUIREMENTS THE SCORE SCORE SCORE OBTAINED SUBMITTED
BY THE
BARANGAY
and Management Management  19% and Below = 0
(BDRRM) Plan or similar How to compute? Officer (LDRRMO)  No BDRRM Plan = 0
plan Accomplishment rate =
A
x 100
B
o A = Total number of
activities/projects
accomplished in the
BDRRM plan

o B= Total number of
activities/projects in the
BDRRM Plan
7. Extent of risk assessment Post activity report of the Barangay Secretary Conducted drills 1 1
and Early Warning drills conducted  Earthquake/Fire/
System (EWS) (Earthquake, fire, etc.) Local Disaster Risk Others = 1
Reduction and  No = 0
Date of drill/s conducted: Management
_____________________ Officer (LDRRMO) With Post-Activity Report: 1 1
______  Yes = 1
 No = 0
Early Warning System Presence of Early Warning 1 1
(EWS) location: System
____________________  Yes = 1
 No = 0

Local risk map Presence of Local risk map 1 1

 Yes = 1
 No = 0
10. Extent of preparedness EO or similar issuance Barangay Secretary With EO or similar 1 1
for effective response and creating the Barangay issuance creating the
recovery Emergency Search and Local Disaster Risk Barangay Emergency
Rescue Team/s Reduction and Search and Rescue Team/s
Management  Yes = 1
Total number of Officer (LDRRMO)  No = 0
Emergency Search and
Rescue Team/s: Provision of training to the 1 1
_________ Emergency Search and
Rescue Team/s:
 Trained in the past 12
months = 1
 INDICATORS DATA DATA SOURCE HOW TO DETERMINE ASSIGNED PASSING SCORE DOCUMENT
REQUIREMENTS THE SCORE SCORE SCORE OBTAINED SUBMITTED
BY THE
BARANGAY
 No training in the past
12 months = 0
Designated/Evacuation Presence of Evacuation 1 1
Center location : Center/Designated
_____________________ Evacuation Center
_______  Yes = 1
 No = 0
Disaster equipment: Disaster equipment 2 1
 2-way radio / mobile  2-way radio / mobile
phone phone = 0.5
 Rescue  Rescue vehicle/Barangay
vehicle/Barangay patrol patrol = 0.5
 Generator set  Generator set = 0.5
 First aid kit  First aid kit / Flashlight
 Flashlight with batteries with batteries = 0.5

TOTAL 20 16

ESSENTIAL AREA 1: SOCIAL PROTECTION

INDICATORS DATA REQUIREMENTS DATA SOURCE HOW TO DETERMINE ASSIGNED PASSING SCORE DOCUMENT
THE SCORE SCORE SCORE OBTAINED SUBMITTED
BY THE
BARANGAY
1. Functionality of the Functionality of the Barangay If the result is: 2 1
Violence Against Women Violence Against Women Secretary  Ideal = 2
(VAW) Desk (VAW) Desk based on MC  Mature = 1
No. 2017-114 dated 30 Local Social  Progressive = 0.5
August 2017 Welfare and  Basic = 0.25
Development  No VAW Desk = 0
VAWC Cases Quarterly Officer Submission of Quarterly 2 1
Reports Reports on VAWC Cases
 1st Qtr submitted:  1st Qtr report submission
__________ = 0.5
 2nd Qtr submitted:  2nd Qtr report submission
_________ = 0.5
 3rd Qtr submitted:  3rd Qtr report submission
 INDICATORS DATA REQUIREMENTS DATA SOURCE HOW TO DETERMINE ASSIGNED PASSING SCORE DOCUMENT
THE SCORE SCORE SCORE OBTAINED SUBMITTED
BY THE
BARANGAY
__________ = 0.5
 4th Qtr submitted:  4th Qtr report submission
__________ = 0.5
Certificate of VAW Desk Person is 1 1
Attendance/Participation and trained
Date of Training/Seminar  Yes = 1
____________  No = 0

4. Access to health services Appointment of Barangay Barangay Presence of Appointment 1 1

in the barangay Health Worker (BHW) Secretary or similar issuance
 Yes = 1
On site inspection  No = 0
Appointment of Barangay Presence of Appointment 1 1
Nutrition Scholar (BNS) or similar issuance
 Yes = 1
 No = 0
Barangay Health Presence of a BHS/C 1 1
Station/Center (BHS/C)  Maintained BHS/C =
Location: 1
____________________  With access to other
BHS/C (check the BHS/C = 0.5
corresponding answer)  None = 0
____ Barangay Availability of services in 2 1
owned/maintained the BHS/C
____ With access to other  Expanded Program on
BHS/C Immunization (EPI) =
0.5
 Maternal Care = 0.5
 Nutrition Care = 0.5
 Other Services = 0.5
 None = 0
8. Functionality of the DILG MC No. 2009-109 Punong Barangay If the result is: 2 1
Barangay Development  BDC Monitoring Form  Ideal = 2
Council (BDC) 2 Barangay  Mature = 1
 BDC Monitoring Form Secretary  Progressive = 0.5
3  Basic = 0.25
 None = 0
 No data = 0
9. Representation of CSOs EO or similar issuance Barangay With EO or similar 3 2
in the Barangay Based organizing each of the Secretary issuance organizing the
Institutions (BBIs) following: BBIs (with CSO
a. BDC 1. BDC representative):
b. BDRRMC 2. BDRRMC  6 to 7 BBIs = 3
 INDICATORS DATA REQUIREMENTS DATA SOURCE HOW TO DETERMINE ASSIGNED PASSING SCORE DOCUMENT
THE SCORE SCORE SCORE OBTAINED SUBMITTED
BY THE
BARANGAY
c. BPOC 3. BPOC  4-5 out of 7 BBIs = 2
d. BADAC 4. BADAC  2-3 out of 7 BBIs = 1
e. BESWMC 5. BESWMC  1 out of 7 BBIs = 0.5
f. BCPC 6. BCPC  No EO or similar
g. Barangay GAD 7. Barangay GAD Focal issuance = 0
Focal Point System Point System

TOTAL 15 10

ESSENTIAL AREA 2: BUSINESS-FRIENDLINESS AND COMPETITIVENESS

INDICATORS DATA REQUIREMENTS DATA SOURCE HOW TO DETERMINE ASSIGNED PASSING SCORE DOCUMENT
THE SCORE SCORE SCORE OBTAINED SUBMITTED
BY THE
BARANGAY
1. Enactment of Barangay Barangay Tax Ordinance Barangay Secretary Presence of Barangay Tax 5 5
Tax Ordinance Ordinance:
Barangay Treasurer  Yes = 5
 No = 0
2. Issuance of Barangay Record book Barangay Treasurer Timeliness of issuance of 10 8
Clearance barangay clearance (within
7 working days):
 90%-100% of
applications met = 10
 80%-89% of applications
met = 8
 70%-79% of applications
met = 6
 60%-69% of applications
met = 4
 50%-59% of applications
 INDICATORS DATA REQUIREMENTS DATA SOURCE HOW TO DETERMINE ASSIGNED PASSING SCORE DOCUMENT
THE SCORE SCORE SCORE OBTAINED SUBMITTED
BY THE
BARANGAY
met = 2
 49% below of
applications met = 0
TOTAL 15 13

ESSENTIAL AREA 3: ENVIRONMENTAL MANAGEMENT

INDICATORS DATA REQUIREMENTS DATA SOURCE HOW TO DETERMINE ASSIGNED PASSING SCORE DOCUMENT
THE SCORE SCORE SCORE OBTAINED BY SUBMITTED
THE
BARANGAY
1. Presence of a  MRF (check the Onsite inspection Presence of MRF: 3 2
Materials Recovery corresponding answer)  Yes = 3
Facility (MRF) ____ Barangay owned  None but with other
pursuant to R.A. 9003 ____ Clustered Brgys materials recovery
scheme = 2
 None = 0
 Location of MRF
 MOA
2. Presence of a Ordinance on segregation of Barangay Secretary Presence of Ordinance on 4 4
Collection System to wastes-at-source segregation of wastes-at-
Ensure Segregation of source
Wastes at Source  Yes = 4
 No = 0
3. Organization of the EO or similar issuance on Barangay Secretary With EO organizing the 2 2
Barangay Ecological the organization of the BESWMC
Solid Waste BESWMC  Yes =2
Management  No = 0
Committee Approved Solid Waste Approved BESWMC 2 2
(BESWMC) Management Program/Plan Program/Plan
(Any template or annotated)  Yes =2
 No = 0
Monthly reports on the Submitted monthly reports 4 3
progress of the program  12 = 4
 9-11 = 3
 6-10 = 2
 1-5 = 1
 None = 0
TOTAL 15 13

We certify to the correctness of the above information.

City/Municipal Assessment Team:

____________________________________
Chairperson

____________________________________
Vice-Chairperson

____________________________________
Member

____________________________________
Member