Republic of the Philippines

Department of Education
REGION VIII
SCHOOLS DIVISION OF LEYTE

PREVENTIVE MAINTENANCE REPORT TOOL

Area
District
Number of Schools in the District
District Office Address
Name of the District Supervisor
Contact No. of District Supervisor
: _________________________________________________
: _________________________________________________
: _________________________________________________
: _________________________________________________
: _________________________________________________
: _________________________________________________

YES NO Observation/s
1 Conducted Classroom Risk-
Assessment
2 Conducted General Classroom
Interior Assessment
3 Conducted Safety and Alarm
System Assessment
4 Conducted Water and Plumbing
System Assessment
5 Conducted Electrical System
Assessment
6 Conducted Electronics System
Assessment

Prepared by:

__________________________ ________________
District DRRM Coordinator Date Signed

Noted by:

__________________________ ________________
District Supervisor/ In-Charge Date Signed