ANNEX A

SSA Monitoring Form 1

LOCALIZATION OF THE SAFE SPACES ACT

COMPLIANCE MONITORING FORM TEMPLATE
(for Province, City/Municipality, and Barangay)
As of December 7, 2023

REGION: 10

PROVINCE: LANAO DEL NORTE

CITY/MUNICIPALITY: KOLAMBUGAN

BARANGAY: MUKAS

COMPLIANCE CHECKLIST ON THE LOCALIZATION OF THE SAFE SPACES ACT

INDICATORS YES NO

1. Mechanism and System

a. Anti-Sexual Harassment (ASH) Desk is established /

b. Designated Anti-Sexual Harassment Enforcers (ASHEs) /

c. ASH Hotline is set up /

d. ASH Referral Network is established /

e. CCTV cameras installed in public spaces

e.1 Major Roads /

e.2. Alleys /

e.3 Sidewalks /

f. Private establishments accessible to the public have N/A N/A

implemented the following measures to prevent and
address gender-based sexual harassment:

f.1 Warning Signs N/A N/A

f.2 Designated ASHEs N/A N/A

f.3 Installed CCTV cameras N/A N/A

f.4 Developed protocols N/A N/A

2. Education and Awareness Campaign

a. Copy of Republic Act No. 11313 (Safe Spaces Act) and /

related ordinances posted in conspicuous places

b. IEC materials that raise awareness for and condemn /

GBSH in streets and public spaces distributed
Note:
1. For Barangay level – Disregard indicator and sub-indicators in the letter “f”.
2. For Provincial level – Disregard indicator in the letter “a”, “b”, “c”, & “d”.

Prepared and submitted by: (MSSMT)

JOHAINA L.DALIGDIG ERNESTO R. LAPINIG

Barangay Secretary Punong Barangay

ANNEX A
 SSA Monitoring Form 1

LOCALIZATION OF THE SAFE SPACES ACT

COMPLIANCE MONITORING FORM TEMPLATE
(for Province, City/Municipality, and Barangay)
As of December 6, 2023

REGION: 10

PROVINCE: LANAO DEL NORTE

CITY/MUNICIPALITY: KOLAMBUGAN

BARANGAY: MUKAS

COMPLIANCE CHECKLIST ON THE LOCALIZATION OF THE SAFE SPACES ACT

INDICATORS YES NO

1. Mechanism and System

a. Anti-Sexual Harassment (ASH) Desk is established /

b. Designated Anti-Sexual Harassment Enforcers (ASHEs) /

c. ASH Hotline is set up /

d. ASH Referral Network is established /

e. CCTV cameras installed in public spaces

e.1 Major Roads /

e.2. Alleys /

e.3 Sidewalks /

f. Private establishments accessible to the public have N/A N/A

implemented the following measures to prevent and
address gender-based sexual harassment:

f.1 Warning Signs N/A N/A

f.2 Designated ASHEs N/A N/A

f.3 Installed CCTV cameras N/A N/A

f.4 Developed protocols N/A N/A

2. Education and Awareness Campaign

a. Copy of Republic Act No. 11313 (Safe Spaces Act) and /

related ordinances posted in conspicuous places

b. IEC materials that raise awareness for and condemn /

GBSH in streets and public spaces distributed
Note:
3. For Barangay level – Disregard indicator and sub-indicators in the letter “f”.
4. For Provincial level – Disregard indicator in the letter “a”, “b”, “c”, & “d”.

Prepared and submitted by: (MSSMT)

JOHAINA L. DALIGDIG ERNESTO R. LAPINIG

Barangay Secretary Punong Barangay