PROCEED TO YOUR RESPECTIVE REGION (E.G.

R1, R2)
THEN LOOK FOR YOUR SPECIFIC PROVINCE or MUNICIPALITY

Republic of the Philippines

Department of the Interior and Local Government
Monitoring LGU Preparedness Actions for a Tropical Cyclone

LGU Information: 6th Class

City or Municipality of: Bucloc

Check the box if "YES" or uncheck if "NO"

LGU Actions Yes / No
1 The LCE is within his/her AOR. Yes

2 C/MLGOO informed LGU of the weather alert with Proof of

Service
Get Organized:
3 Convened LDRRMC within 24 hours upon receiving a severe
weather bulletin Yes 4.1.1.1.
4 Reviewed LDRRM/Contingency Plans and Hazard Risk Maps Yes
Engaged LHO and/or LESU to ensure the inclusion and
4.1 implementation of descriptive epidemiology and pattern analyses
in the DRRM, and the contingency plans Yes 4.1.1.2.
5 Estimated number of evacuees Yes
Conducted PDRA and prepared appropriate response plan Yes 4.1.1.1
6 Response plan includes actions ensuring compliance of minimum
public heath standards Yes 4.1.1.1
7 Organized Administrative/Logistical Support Team Yes
8 Organized Search, Rescue and Retrieval Teams Yes
9 Organized Security Teams Yes
10 Organized Medical Teams in ECs Yes
11 Organized Clearing Operations Team Yes
12 Organized Monitoring and Reporting Team Yes
13 Activated 24/7 Emergency Operations Center Yes
14 Activated Incident Command System No

15 Conducted inventory of supplies, equipment and stockpile of

goods
16 Assessed Evacuation Centers (functionality and safe use) Yes
17 Conducted clearing operations and assessed structures No
Placed adequate guide markers at strategic locations for
18 evacuees and operations teams No
Alert Communities:
19 Informed Punong Barangays of weather advisory Yes
Disseminated public warnings thru established warning systems
and weather bulletins, especially families in identified danger
20 zones Yes
(For coastal and island barangays) Warned fisherfolks to take
21 precautionary measures
(For coastal and when goingIssued
island barangays) out toprohibitions
sea for sea
voyage and fishing (at sea, lakes, rivers and other deep waters)
22 and prevented people to cross any body of water
 Advised households to prepare survival kits/ secure roof, wall,
23 power lines
Issued suspension of classes for appropriate levels and
24 suspension of work for private and government offices
Execute Plans:
25 Prepared Evacuation Centers Yes
25.1 With hand washing area and adequate drainage 4.1.1.1.
25.2 With steady supply of clean water
25.3 With sufficient quantities of hand soap
25.4 With monitoring mechanism to monitor the proper wearing of face
masks and maintaining proper physical distancing
With facilities fo proper disposal of disposable face masks and
25.5 infectious wastes (such as PPEs, tissue paper, cotton balls,
disposable syringe, needles, etc.)
26 Conducted pre-emptive/forced evacuation
27 Conducted mass feeding
28 Cancelled travel authorities for SAR and frontline personnel
Repacked and prepositioned food packs and non-food items for
29 evacuees
Dispatched and prepositioned SAR/SRR, Medical, Security and
30 Clearing Operations teams
31 Advised Security Teams to maintain peace and order
32 Secured communication, power and water supply lines
Deployed brgy health workers/volunteers to provide medical,
33 psycho-social, and spiritual counselling to the evacuees
Coordinated with PNP and BFP for reporting of casualties (dead,
34 missing, injured) and damage to structures, if any
C/MHO coordinated with PNP and funeral parlors to manage
35 dead, if any
DILG MC 2020-125 (COVID-19 related Early Preparedness
Checklist)
36 Conducted CCCM simulation exercises to determine gaps, and
implemented solutions
37 Assess the structual integrity and capacity of vital facilities, such
as: 4.1.1.4.
37.1 LIGTAS COVID-19 Centers
37.2 Health Centers
37.3 Hospitals for COVID-19 cases
37.4 Public buildings (public markets, land transportation terminals and
ports)
37.5 Lifelines (power, water, and communication)
38 Assessed functionality of established Early-Warning Systems
(EWS) 4.1.1.6.
Ensure that family Go Bag/Emergency Balde includes COVID-19
39 essentials (soap, 70% alcohol, bleach, surgical or cloth masks,
etc) 4.1.1.8.
40 Engaged into a Mutual Aid Agreements with other LGUs for
sharing of resources, emergency services, use of evacuation
centers, community isolation facilities and others) 4.1.1.9.

Other Preparedness Actions not indicated in the Checklist:

Certified True and Correct:

Brgy. Secretary
 STATUS OF EVACUATION
Confirmation Slip

This is to certify that the following barangays in the City/Municipality of ____________, Province of ___________ conducted p

FOR EVACUATION
Name of Barangay Name/Location of Evacuation Centers
No. of Families No. of Families
(Ex. Poblacion Elementary School)

Notes:
1. This Certification has to be signed by the Local Chief Executive.
2. This has to be submitted not later than 24 hours before anticipated landfall and updated every 5 hours.
3. DILG Field Officer has to ensure compliance to this requirement.
4. Use additional sheets, if necessary.
EVACUATION
tion Slip

__________ conducted pre-emptive/forced evacuation with details indicated below:

EVACUATION CONDUCTED
Name/Location of Evacuation Centers (Ex. Poblacion Elementary
Date (mm/dd/yyyy)
School)

Certified by:

Name of Local Chief Executive

Date: