SGLGB Form No.

SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY

Assessment Period: CY 2018
Data Capture Form

Identifying Information

Region : _______________________________
Barangay : _______________________________
City/Municipality : _______________________________
Province : _______________________________

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
Barangay Anti-Drug BADAC based on Secretary  High = 8
Abuse Council (BADAC) DILG-DDB JMC No.  Moderate = 4
2018-01 and DILG MC DILG  Low = 2
No. 2018-135 City/Municipal  No data = 0
Office

2. Functionality of the BPOC Monitoring DILG If the result is: 5 4

Barangay Peace and Form 2 based on DILG City/Municipal  Ideal = 5
Order Committee (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: 6 4
Lupong Tagapamayapa on DILG MC No. 2016- City/Municipal  95-100 = 6
Incentives Awards 58 Office  90-94 = 5
(LTIA)  85-89 = 4
 80-84 = 3
 75-79 = 2
 Below 75 = 1
 No data = 0
4. Maintenance of Record of RBI or similar system Barangay  With RBI = 2 1 1
Barangay Inhabitants Date of last update: Secretary  Without RBI = 0
(RBI) _______

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 4 4
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 3 3
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 8 6
______________________ 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% 2 2
Barangay Disaster Risk the Barangay : PhP Secretary/ BDRRM Fund
Reduction and __________ Barangay allocation
Management Treasurer  Yes = 2
Committee (BDRRMC)  No = 0

EO or similar issuance Local Disaster BDRRMC supported 1 1

creating the BDRRMC Risk Reduction with EO or similar
and Management issuance
Officer  Yes = 1
(LDRRMO)  No = 0
 No data = 0
Approved BDRRM With Approved 2 1
Plan BDRRM Plan
 Yes, using the
Approved plan using prescribed template =
the prescribed 2
template (LISTO)  Yes, not using the
prescribed template
=1
 No = 0
Minutes of the Conduct of quarterly 2 1
quarterly meeting meeting
 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
Utilization Report Utilization of the 70% 1 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
𝑥 100 (LDRRMO)
𝐵

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 Conducted drills 1 1
assessment and Early the drills conducted Secretary  Earthquake/Fire/
Warning System (EWS) (Earthquake, fire, etc.) Others = 1
Local Disaster  No = 0
Date of drill/s Risk Reduction
conducted: and Management With Post-Activity 1 1
_____________________ Officer Report:
______ (LDRRMO)  Yes = 1
 No = 0
Early Warning System Presence of Early 1 1
(EWS) location: Warning System
____________________  Yes = 1
 No = 0
 INDICATORS DATA DATA SOURCE HOW TO ASSIGNED PASSING SCORE DOCUMENT
REQUIREMENTS DETERMINE THE SCORE SCORE OBTAINED SUBMITTED
SCORE BY THE
BARANGAY
Local risk map Presence of Local risk 1 1
map
 Yes = 1
 No = 0
4. Extent of preparedness EO or similar issuance Barangay With EO or similar 1 1
for effective response creating the 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
Rescue Team/s: (LDRRMO) Provision of training to 1 1
_________ 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 : Center/Designated
_____________________ Evacuation Center
_______  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 Appointment of Barangay Presence of 1 1

services in the Barangay Health Secretary Appointment or
barangay Worker (BHW) similar issuance
On site  Yes = 1
inspection  No = 0
Appointment of Presence of 1 1
Barangay Nutrition Appointment or
Scholar (BNS) similar issuance
 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
 INDICATORS DATA DATA SOURCE HOW TO ASSIGNED PASSING SCORE DOCUMENT
REQUIREMENTS DETERMINE THE SCORE SCORE OBTAINED SUBMITTED
SCORE BY THE
BARANGAY
____ Barangay Availability of services 2 1
owned/maintained in the BHS/C
____ 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 Monitoring Barangay  Ideal = 2
Council (BDC) Form 2  Mature = 1
 BDC Monitoring Barangay  Progressive = 0.5
Form 3 Secretary  Basic = 0.25
 None = 0
 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 (with CSO
(BBIs) 1. BDC representative):
a. BDC 2. BDRRMC  6 to 7 BBIs = 3
b. BDRRMC 3. BPOC  4-5 out of 7 BBIs = 2
c. BPOC 4. BADAC  2-3 out of 7 BBIs = 1
d. BADAC 5. BESWMC  1 out of 7 BBIs = 0.5
e. BESWMC 6. BCPC  No EO or similar
issuance = 0
f. BCPC 7. Barangay GAD Focal
g. Barangay GAD Point System
Focal Point System

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 Secretary Tax Ordinance:
Ordinance  Yes = 5
Barangay  No = 0
Treasurer
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
9003 owned scheme = 2
 None = 0
____ Clustered Brgys

 Location of MRF
 MOA
2. Presence of a Ordinance on Barangay Presence of Ordinance 4 4
Collection System to segregation of wastes-at- Secretary on segregation of
source wastes-at-source
 INDICATORS DATA DATA SOURCE HOW TO ASSIGNED PASSING SCORE DOCUMENT
REQUIREMENTS DETERMINE THE SCORE SCORE OBTAINED BY SUBMITTED
SCORE THE
BARANGAY
Ensure Segregation  Yes = 4
of Wastes at Source  No = 0
3. Organization of the EO or similar issuance Barangay With EO organizing 2 2
Barangay Ecological on the organization of Secretary the BESWMC
Solid Waste the BESWMC  Yes =2
Management  No = 0
Committee Approved Solid Waste Approved BESWMC 2 2
(BESWMC) Management Program/Plan
Program/Plan  Yes =1
(Any template or  No = 0
annotated)
Monthly reports on the Submitted monthly 4 3
progress of the program 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

____________________________________
Vice-Chairperson

____________________________________
Member

____________________________________
Member