(ocr Dik, _R Bia Movicsey | Republic of the Philippines ee fy DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT REGION Ill - PROVINCE OF NUEVA ECIJA ADVISORY To : ALL CLUSTER TEAM LEADERS, CITY AND MUNICIPAL LOCAL GOVERNMENT OPERATIONS OFFICERS (C/MLGOOs) SUBJECT : ADDITIONAL SHEET TO FORM 2G FOR (ENGINEER'S CERTIFICATION) DATE June 19, 2023 This has reference to the conduct of the 2023 Seal of Good Local Governance (SGLG) Regional On-Site Assessment for the local government units of Nueva Ecija. In line with this, we are providing the attached Additional Sheet to Form 2G for LGU Health Facility (Engineer's Certification). The same sheet is also uploaded to our shared folder thru https://bit.ly/NE2023SGLGMats, Further, we would like to reiterate to kindly ensure that the following SGLG forms are properly accomplished, duly signed, and readily available on the scheduled assessment of the LGU, together with their compilation of Means of Verification (MOVs) documents: Form Office! Person Responsible Forms 2.1-2.10 Documentary Checklist _DILG Field Officer Forms 2A-2N Certifications for C/Ms LGU Department Heads; LLGU-based Offices; DILG Field Officers Form 2E Photo Documentation DILG Field Officer For information and appropriate action — ‘AC JR., CESO V Pioyincial Director “Matino, Mahusay at Meaasahan” DILG NUEVA ECA PROVINCIALOFFICE Ramoso Street, Old Capitol Compound, Cabanatuan City, Nueva Ecija Telephone No: (044) 940 ~ 0616 UhayAdditional Sheet for Form 2G for LGU Health Facility (for Provinces, Cities, and Municipalities) Name of Facility = Address: Kindly provide at least two photos per feature. As much as possible, provide pictures of diferent structures (e.g, different toilets reflecting the minimum requirements). If only one structure is available, pictures should be taken from different perspectives OR should show different minimum requirements. SWITCHES, CONTROLS, BUZZERS (if applicable) Minimum Requirements: Gi Manual switches shall be positioned within 1.20 ‘m{o 1.30 m above the floor, at least at the PWD || _ washrooms and toilets Ci Manual switches should be located no further | | | than 0.20 from the latch side of the door, at least || atthe PWD washrooms and toilets, | | | other Remarks (it any) ‘Other PWD-friendly space/facilitylequipment / Remarks (If any) tepis eeCertified by: Saar over Pid Namo ‘Signature ovr Pied Namo ProvincialCity/Municipal Engineer Provincial(City/Municipal PDA Head/Focal Person Attested by: ‘Signature over Printed Name Local Chief Executive Official Release of this Certification (Please affix the official LGU stamp below) iopMs