ANNEX C

PERSONS WITH DISABILITY AFFAIRS OFFICE / FOCAL PERSON

Functionality Assessment Form

Year under Review : 2022

Date of Submission : 01/06/2023

Region : VII
Province : SIQUIJOR
City/Mun. : MARIA

INDICATOR RATING REMARKS

Establishment 20%
Choose one:
a1. For Provinces, Cities, and 1st to 3rd income class
Municipalities, the PDAO is established through 20%
Ordinance (20%)
- or -
a2. For 4th to 6th income class Municipalities, the
PWD FP is appointed by Executive Order (20%)
Accessibility 15%
Choose one:
a1. Physical location of PDAO is easily accessible to
Persons with Disabilities (5%) 10%
- or -
a2. Physical location of PWD FP office/desk is easily
accessible to Persons with Disabilities (5%)
b. PDAO/FP has installed accessibility facilities/
devices such as:
o Ramps (1%)
o Support rails (1%)
o Reserved parking space for Persons with
Disabilities (1%)
o Wheelchair-friendly doors (1%) 3%
o Wheelchair-friendly restrooms (1%)
o Braille (1%)
o Sign language interpreters (1%)
o Assistive signages (1%)
o Tactile tiles (1%)
o Others: ______________________ (1%)
Resources 10%
a. Furniture and Vehicle
o Tables and chairs (1%)
o Filing cabinet/ storage area (1%) 3%
o Sofa bed, folding bed, or mat (1%)
o Availability of vehicle and/or transportation
expenses to convey Persons with Disabilities
(1%)
b. Equipment and Supplies
o Landline or mobile phone (1%)
o Computer, especially for PWD database 2%
purposes (1%)
o Camera (0.5%)
 ANNEX C

o Voice Recorder (0.5%)

o First aid kit and other medicines (1%)

c. Monitoring Tools
 Logbooks
o Logbook for violations of Ras 7277,
9442, 10754 (0.5%)
o Logbook recording violence against 0.5%
Persons with Disabilities (0.5%)
 Forms 0.5%
o Feedback Form (0.5%)
Policies, Plans, and Budget 15%
a. PDAO/FP budget allocated in IRA (7.5%) 7.5%
b. PDAO/FP PPAs integrated in AIP (7.5%) 7.5%
Conduct of Meetings 5%
a. Regular conduct of public consultations by the
PDAO/FP with Persons with Disabilities in the 1%
community on the formulation and implementation of
local policies for their well-being (2.5%)
b. Regular conduct of townhall meetings by the
PDAO/FP with Persons with Disabilities in the 2%
community to get their views and concerns on local
and national issues affecting them (2.5%)
Partnership Initiatives 10%
a. PDAO/FP actively encourages and coordinates
with CSOs and the private sector in the conduct of
programs, initiatives, and activities that would engage 7%
the participation of and provide benefit to Persons
with Disabilities (10%)
Accomplishments 25%
a. PDAO/FP has submitted the Annual
Accomplishment Report (choose one):
o in time (25%) 25%
o 1 to 2 working days late (20%)
o 3 to 4 working days late (15%)
o 5 to 6 working days late (10%)
o 7 working days late and beyond (5%)
OVERALL RATING 90%

LEVEL OF FUNCTIONALITY Indicate level below:

Basic 20% and below
Progressiv 21% to 50% IDEAL
e
Mature 51% to 80%
Ideal 81% to 100%

Assessed by:
 ANNEX C

ZOSILITO C. LIGUTOM
MGLOO