SGLGB Form No.

SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY

Assessment Period: CY 2018
Data Capture Form

Identifying Information

Region : IV - A
Barangay : TINANDOG
City/Municipality : ATIMONAN
Province : QUEZON

CORE AREA 1: PEACE AND ORDER

INDICATORS DATA DATA SOURCE HOW TO ASSIGNED PASSING SCORE DOCUMENT

REQUIREMENTS DETERMINE THE SCORE SCORE OBTAINED SUBMITTED
SCORE BY THE
BARANGAY
1. Functionality of the Functionality of Barangay If the result is: 8 4 DILG
Barangay Anti-Drug BADAC based on Secretary  High = 8
Abuse Council (BADAC) DILG-DDB JMC No. DILG  Moderate = 4
2018-01 City/Municipal  Low = 2
Office  No data = 0

2. Functionality of the BPOC Monitoring DILG If the result is: 5 3

Barangay Peace and Form 2 based on DILG City/Municipal  Ideal = 5
Order Council (BPOC) MC No. 2008-101 Office  Mature = 4
 Progressive = 3
 Basic = 2
 BPOC organized = 1
 No BPOC= 0
 No data = 0
3. Performance Rate in the LTIA Form 003 based DILG If the result is: 4 3
Lupong Tagapamayapa on DILG MC No. 2016- City/Municipal  90-100 = 4
Incentives Awards 58 Office  80-89 = 3
(LTIA)  60-79 = 2
 Below 60 = 1
 No data = 0
4. Maintenance of Record of RBI or similar system Barangay  With RBI = 3 3 3
Barangay Inhabitants Date of last update: Secretary  Without RBI = 0
(RBI) December, 2018

TOTAL 20 13

CORE AREA 2: FINANCIAL ADMINISTRATION

INDICATORS DATA DATA SOURCE HOW TO PERFECT PASSING SCORE DOCUMENT

REQUIREMENTS DETERMINE THE SCORE SCORE OBTAINED SUBMITTED
SCORE BY THE
BARANGAY
1. Compliance with the BFDP Monitoring DILG Presence of BFDP 8 6
Barangay Full Form 1 and Form 2 City/Municipal Board
Disclosure Policy pursuant to DILG MC Office  Yes = 4
(BFDP) No. 2014-81  No = 0
Onsite Inspection Compliance to the 4 4
CY 2018, 4th Qtr design pursuant to
compliance: Annex 8 of the DILG
MC No. 2014-81:
 Yes = 3
Location of the BFD  No = 0
Board: If the result of CY 3 3
2018, 4th Qtr
compliance is:
Full Compliance = 8
Partial Compliance:
o 7 financial
documents posted
=7
o 5-6 financial
documents posted
=6
o 3-4 financial
documents posted
=4
o 1-2 financial
documents posted
=2
Non-compliance = 0
No data = 0
2. Percentage Increase in Barangay Budget Barangay With increase? 5 5
local resources Preparation Form No. Treasurer  Yes = 5
2: Actual Income and  No = 0
Expenditure
 Total amount collected City/Municipal
from fees and charges: Accountant

CY 2017 PhP
CY 2018 PhP

Difference : PhP

Percentage increase:

TOTAL 20 18

CORE AREA 3: DISASTER PREPAREDNESS

INDICATORS DATA DATA SOURCE HOW TO ASSIGNED PASSING SCORE DOCUMENT

REQUIREMENTS DETERMINE THE SCORE SCORE OBTAINED SUBMITTED
SCORE BY THE
BARANGAY
1. Functionality of the 5% BDRRM Fund in Barangay With at least 5% 8 2
Barangay Disaster Risk the Barangay : PhP Secretary/Barang BDRRM Fund
Reduction and ay Treasurer allocation
Management  Yes = 2
Committee (BDRRMC)  No = 0
EO or similar issuance Local Disaster BDRRMC supported
creating the BDRRMC Risk Reduction with EO or similar
and Management issuance
Officer  Yes = 1 1
(LDRRMO)  No = 0
 No data = 0
Approved BDRRM With Approved
Plan BDRRM Plan
Yes, using the
Approved plan using prescribed template = 1
the prescribed 2
template Yes, not using the
prescribed template
=1
No = 0
Minutes of the Conduct of quarterly
quarterly meeting meeting 1
 4 out of 4 = 2
 2 or 3 out of 4 = 1
 1 out of 4 = 0
 No = 0
 No data = 0
 INDICATORS DATA DATA SOURCE HOW TO ASSIGNED PASSING SCORE DOCUMENT
REQUIREMENTS DETERMINE THE SCORE SCORE OBTAINED SUBMITTED
SCORE BY THE
BARANGAY
Liquidation report Utilization of the 70% 1
BDRRM Fund
 50% and above = 1
 Less than 50% =
0.5
 No = 0
 No data = 0

2. Accomplishment rate of  Approved BDRRM Barangay Rate of 3 2

the activities/projects Plan Secretary Accomplishment:
reflected in the  Accomplishment 60% and above = 3
Barangay Disaster Risk Report Local Disaster  40 – 59% = 2
Reduction and Risk Reduction  20 – 39% = 1
Management (BDRRM) How to compute? and Management 19% and Below = 0
Plan or similar plan Accomplishment rate = Officer No BDRRM Plan = 0
𝐴
𝐴 100 (LDRRMO)
𝐴

o A = Total number of
activities/projects
accomplished in the
BDRRM plan

o B= Total number of
activities/projects in
the BDRRM Plan
3. Extent of risk Post activity report of Barangay Presence of Local risk 1 1
assessment and Early the drills conducted Secretary map
Warning System (EWS) (Earthquake, fire, etc.)  Yes = 1
Local Disaster  No = 0
Date of drill/s Risk Reduction Presence of Early 1 1
conducted: and Management Warning System
Officer  Yes = 1
(LDRRMO)  No = 0

Local risk map Conducted drills 1 1

 Earthquake/Fire/O
thers = 1
 No = 0
 INDICATORS DATA DATA SOURCE HOW TO ASSIGNED PASSING SCORE DOCUMENT
REQUIREMENTS DETERMINE THE SCORE SCORE OBTAINED SUBMITTED
SCORE BY THE
BARANGAY
Early Warning System With Post-Activity 1 1
(EWS) location: Report:
 Yes = 1
 No = 0
4. Extent of preparedness EO or similar issuance Barangay With EO or similar 2 1
for effective response creating Barangay Secretary issuance creating the
and recovery Emergency Search and Barangay Emergency
Rescue Team/s Local Disaster Search and Rescue
Risk Reduction Team/s
Total number of and Management Yes = 1
Emergency Search and Officer No = 0 1
Rescue Team/s: (LDRRMO) Provision of training to
BDRRMC the Emergency Search
and Rescue Team/s:
Trained in the past
12 months = 1
No training in the
past 12 months = 0
Designated/Evacuation Presence of Evacuation 1 1
Center location : Multi Center/Designated
Purposed Hall & Evacuation Center
Chapel (R. Catholic)  Yes = 1
 No = 0
Disaster equipment: Disaster equipment 2 1
 2-way radio / mobile 2-way radio / mobile
phone phone = 0.5
 Rescue Rescue
vehicle/Barangay vehicle/Barangay
patrol patrol = 0.5
 Generator set Generator set = 0.5
 First aid kit First aid kit /
 Flashlight with Flashlight with
batteries batteries = 0.5

TOTAL 20 16

ESSENTIAL AREA 1: SOCIAL PROTECTION

 INDICATORS DATA DATA SOURCE HOW TO ASSIGNED PASSING SCORE DOCUMENT
REQUIREMENTS DETERMINE THE SCORE SCORE OBTAINED SUBMITTED
SCORE BY THE
BARANGAY
1. Functionality of the Functionality of the Barangay If the result is: 2 1
Violence Against Violence Against Women Secretary  Ideal = 2
Women (VAW) Desk (VAW) Desk based on  Mature = 1
MC No. 2017-114 dated Local Social  Progressive = 0.5
30 August 2017 Welfare and  Basic = 0.25
Development  No VAW Desk = 0
VAWC Cases Quarterly Officer Submission of 2 1
Reports Quarterly Reports on
1st Qtr submitted: VAWC Cases
1st Qtr report
2nd Qtr submitted: submission = 0.5
2nd Qtr report
3rd Qtr submitted: submission = 0.5
3rd Qtr report
4th Qtr submitted: submission = 0.5
4th Qtr report
submission = 0.5
Certificate of VAW Desk Person is 1 1
Attendance/Participation trained
and Date of  Yes = 1
Training/Seminar  No = 0

2. Access to health EO or similar issuance Barangay Presence of EO or 1 1

services in the on the Appointment of Secretary similar issuance on the
barangay Barangay Health appointment of BHW
Worker (BHW) On site  Yes = 1
inspection  No = 0
EO or similar issuance Presence of EO or 1 1
on the appointment of similar issuance on the
Barangay Nutrition appointment of BNS
Scholar (BNS)  Yes = 1
 No = 0
Barangay Health Presence of a BHS/C 1 1
Station/Center (BHS/C)  Maintained BHS/C
Location: =1
 With access to
BHS/C (check the other BHS/C = 0.5
corresponding answer)  None = 0
Barangay Availability of services 2 1
owned/maintained in the BHS/C
 INDICATORS DATA DATA SOURCE HOW TO ASSIGNED PASSING SCORE DOCUMENT
REQUIREMENTS DETERMINE THE SCORE SCORE OBTAINED SUBMITTED
SCORE BY THE
BARANGAY
With access to other Expanded Program
BHS/C on Immunization
(EPI) = 0.5
Maternal Care = 0.5
Nutrition Care = 0.5
Other Services = 0.5
None = 0
3. Functionality of the DILG MC No. 2009-109 Punong If the result is: 2 1
Barangay Development  BDC Form 1 Barangay  Ideal = 2
Council (BDC) (Assessment Form)  Mature = 1
 BDC Monitoring Barangay  Progressive = 0.5
Form 2 Secretary  Basic = 0.25
 BDC Monitoring  None = 0
Form 3  No data = 0

4. Representation of EO or similar issuance Barangay With EO or similar 3 2

CSOs in the Barangay organizing each of the Secretary issuance organizing
Based Institutions following: the BBIs:
(BBIs) 1. BDC 6 out of 7 BBIs = 3
a. BDC 2. BDRRMC 4-5 out of 7 BBIs = 2
b. BDRRMC 3. BPOC 2-3 out of 7 BBIs = 1
c. BPOC 4. BADAC 1 out of 7 BBIs = 0.5
No EO or similar
d. BADAC 5. BESWMC
issuance = 0
e. BESWMC 6. BCPC
f. BCPC 7. Barangay GAD Focal
g. Barangay GAD Point System
Focal Point System
CSO Assembly/Election
Report

TOTAL 15 10

ESSENTIAL AREA 2: BUSINESS-FRIENDLINESS AND COMPETITIVENESS

INDICATORS DATA DATA SOURCE HOW TO ASSIGNED PASSING SCORE DOCUMENT

REQUIREMENTS DETERMINE THE SCORE SCORE OBTAINED SUBMITTED
SCORE BY THE
BARANGAY
1. Enactment of Barangay Tax Ordinance Barangay Presence of Barangay 5 5
Barangay Tax Barangay Revenue Code Secretary Tax Ordinance:
Ordinance
 INDICATORS DATA DATA SOURCE HOW TO ASSIGNED PASSING SCORE DOCUMENT
REQUIREMENTS DETERMINE THE SCORE SCORE OBTAINED SUBMITTED
SCORE BY THE
BARANGAY
Barangay  Presence of
Treasurer Barangay Tax
Ordinance = 5
 No Barangay Tax
Ordinance = 0
2. Issuance of Barangay Record book Barangay Timeliness of issuance 10 8
Clearance Treasurer of barangay clearance
(within 7 working
days):
90%-100% of
applications met = 10
80%-89% of
applications met = 8
70%-79% of
applications met = 6
60%-69% of
applications met = 4
50%-59% of
applications met = 2
49% below of
applications met = 0
TOTAL 15 13

ESSENTIAL AREA 3: ENVIRONMENTAL MANAGEMENT

INDICATORS DATA DATA SOURCE HOW TO ASSIGNED PASSING SCORE DOCUMENT

REQUIREMENTS DETERMINE THE SCORE SCORE OBTAINED BY SUBMITTED
SCORE THE
BARANGAY
1. Presence of a  MRF (check the Onsite inspection Presence of MRF: 3 2
Materials Recovery corresponding  Yes = 3
Facility (MRF) answer)  None but with other
pursuant to R.A. Barangay materials recovery
scheme = 2
9003 owned
 None = 0
Clustered Brgys

 Location of MRF
 MOA
2. Presence of a Ordinance on Barangay Presence of Ordinance 4 4
Collection System to segregation-at-source Secretary on segregation of
Ensure Segregation wastes-at-source
of Wastes at Source  Yes = 3
 No = 0
 INDICATORS DATA DATA SOURCE HOW TO ASSIGNED PASSING SCORE DOCUMENT
REQUIREMENTS DETERMINE THE SCORE SCORE OBTAINED BY SUBMITTED
SCORE THE
BARANGAY
3. Organization of the EO or similar issuance Barangay If the result is: 2 2
Barangay Ecological on the organization of Secretary EO organizing the
Solid Waste the BESWMC BESWMC
Management  Yes =1
Committee  No = 0
(BESWMC) Approved Solid Waste Approved BESWMC 2 2
Management Program/Plan
Program/Plan  Yes =1
(Any template or  No = 0
annotated)
Monthly reports Submitted monthly 4 3
reports
 12 = 4
 9-11 = 3
 6-10 = 2
 1-5 = 1
 None = 0
TOTAL 15 13

We certify to the correctness of the above information.

City/Municipal Assessment Team

Chairperson, C/M Assessment Team

Vice-Chairperson, C/M Assessment Team

Member, C/M Assessment Team

Member, C/M Assessment Team