Appendix B BE Form 01

Republic of the Philippines Department of Education Region XI Division of Davao City DALIAON DISTRICT DON JUAN DELA CRUZ CENTRAL ELEMENTARY SCHOOL School Year 2010 - 2011 BRIGADA ESKWELA PHYSICAL FACILITIES REPAIR AND MAINTENANCE NEEDS ASSESSMENT FORM (To be accomplished by the School Physical Facilities Coordinator)

Instruction: Conduct an occular inspection of the school physical facilities listed below. Then provide the needed information to facilitate the improvement to be done on this identified facilities. (If needed, you may use separate forms for each classroom or school facility.) FACILITIES Condition Remarks Nature of Improvement (check one) Needed Satisfactory Unsatisfactory If unsatisfactory, (e.g. Repair, repainting, describe the problem replacement, etc.)

Prepared by: MANUEL LUIS D. TAYAO

Noted:

School Physical Facilities Coordinator

Date Prepared

e the needed information to facilitate the improvement Material Resources Needed (Indicate kind and quantity) Manpower Needed (Indicate quantity and nature of labor service needed)

ALVIN B. JUMUAD

ESP II