Professional Documents
Culture Documents
1
Assessment for the Seal of Good Local Governance Financial Administration
CY 2016
2 The LGU fully complied with the posting of financial documents, bids and Yes No
awards in three (3) conspicuous places (2015 Annual and 4th quarter
posting period documents).
Kindly specify location of posting.
Area 1
Area 2
Area 3
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Department of the Interior and Local Government
Assessment for the Seal of Good Local Governance Form CM 2.1
Financial Administration
CY 2016
FINANCIAL PERFORMANCE
4(N) Average local revenue growth from CYs 2012 to 2014 is greater than 0%. Yes No Yes No
Additional Observation or Information from RAT Members (tick as appropriate):
Discrepancy in LGU and NGA data; with accomplished Change Request Form
No discrepancy in LGU and NGA data
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Department of the Interior and Local Government
Assessment for the Seal of Good Local Governance Form CM 2.1
Financial Administration
CY 2016
Collected by:
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Department of the Interior and Local Government Form CM 2.2
Assessment for the Seal of Good Local Governance Disaster Preparedness
CY 2016
2 The LGU is aware of its hazards e.g., flood, landslide, storm surge, tsunami, Yes No Yes No
etc.
Additional Observation or Information from RAT Members:
3 Risk and/ or vulnerability assessment is conducted, and information is linked Yes No Yes No
to plans.
Additional Observation or Information from RAT Members:
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Department of the Interior and Local Government
Form CM 2.2
Assessment for the Seal of Good Local Governance Disaster Preparedness
CY 2016
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Department of the Interior and Local Government
Form CM 2.2
Assessment for the Seal of Good Local Governance Disaster Preparedness
CY 2016
8 Search and Rescue or Emergency Response Teams are organized, Yes No Yes No
equipped and trained.
If yes, kindly indicate if the SARs meet or have the following:
8.1 Organization
8.1.1 Teams organized within the last three (3) years Yes No Yes No
8.2 Equipment
8.2.1 Motorized Vehicle Yes No Yes No
8.2.2 Water rescue kit (at the minimum: rope, life jacket, flotation Yes No Yes No
ring or alternate
8.2.3 Extrication Kit (at the minimum: spine board, shovel or Yes No Yes No
alternate digging device)
8.2.4 Personal Protective Equipment (at the minimum: helmet, Yes No Yes No
goggles, work gloves, boots)
8.2.5 First aid kit Yes No Yes No
8.2.6 Emergency medical kit Yes No Yes No
8.3 Training(s) within the last three (3) years
8.3.1 Flood/swift water/ ravine search and rescue Yes No Yes No
8.3.2 Basic life support Yes No Yes No
Additional Observation or Information from RAT Members:
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Department of the Interior and Local Government
Form CM 2.2
Assessment for the Seal of Good Local Governance Disaster Preparedness
CY 2016
Collected by:
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Department of the Interior and Local Government Form CM 2.2A
Assessment for the Seal of Good Local Governance Disaster Preparedness
CY 2016
CERTIFICATION
_____% of barangays with approved Community-Based Disaster Risk Reduction and Management
Plans; OR,
_____% of barangays with programs, plans and activities (PPAs) that include the development or
conduct of DRR-related undertakings such as information, education communication efforts
by communities as approved by the Barangay Development Council; and
This Certification is issued for the purpose of the Seal of Good Local Governance assessment.
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Department of the Interior and Local Government Form CM 2.3
Assessment for the Seal of Good Local Governance Social Protection
CY 2016
1 The LGU has a mechanism for handling cases filed in Barangay-Violence Yes No Yes No
Against Women and their Children (VAWC) desks or similar entities within
its jurisdiction as evidenced by an executive order or equivalent issuance.
1.1 If yes, provide how many barangays Yes No
submitted their VAWC quarterly reports to the %
LSWDO for 2015 (based on Form CM 2.3A)
Additional Observation or Information from RAT Members:
2 (N) The LGU manages a DSWD-accredited residential care facility for the Yes No Yes No
vulnerable sectors (e.g. children, women, PWD or senior citizen).
Additional Observation or Information from RAT Members (tick as appropriate):
Discrepancy in LGU and NGA data; with accomplished Change Request Form
No discrepancy in LGU and NGA data
3 The Local Social Welfare and Development Office has a registered social Yes No Yes No
worker.
If yes:
3.1 Specify PRC registration number and date of validity.
Registration Number :
Valid Until :
3.2 The registered social worker being referred to is (tick one answer
only):
The Department Head Yes
Not the Department Head since he/she was hired prior to the Yes
enactment of RA 9433, but a technical staff of the Office.
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Department of the Interior and Local Government
Form CM 2.3
Assessment for the Seal of Good Local Governance Social Protection
CY 2016
4 (N) The LGUs main hospital/health facility/rural health unit is Philhealth- Yes No Yes No
accredited for 2015.
If yes, kindly indicate if facility is accredited in the following:
4.1 Maternal Care Package (MCP) Yes No Yes No
4.2 Primary Care Benefits (PCB) Yes No Yes No
4.3 TB-Directly Observed Treatment Short Course (TB-DOTS) Yes No Yes No
Additional Observation or Information from RAT Members (tick as appropriate):
Discrepancy in LGU and NGA data; with accomplished Change Request Form
No discrepancy in LGU and NGA data
5 The 2015 Local School Board Plan is aligned with the 2015 School Yes No Yes No
Improvement Plan (based on Form CM 2.3B).
Additional Observation or Information from RAT Members:
7 The LGU has designated express lanes or has posted priority signages for Yes No Yes No
persons with disabilities, senior citizens and pregnant women in the areas
of frontline service(s).
If yes, kindly indicate if designated express lanes or priority signage(s) are
present in the following:
7.1 Business Processing and Licensing Office Yes No Yes No
7.2 Office of the Civil Registry Yes No Yes No
7.3 LGU Main Hospital or heath facility Yes No Yes No
Additional Observation or Information from RAT Members:
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Department of the Interior and Local Government
Assessment for the Seal of Good Local Governance Form CM 2.3
Social Protection
CY 2016
8 (N) The LGU has physical features or facilities to enable the mobility of persons Yes No Yes No
with disabilities.
If yes, kindly indicate if the following physical features or conditions are
present:
8.1 City/Municipal Hall
8.1.1 Ramp with handrails at the entrance or exit Yes No Yes No
If yes (for RAT members):
8.1.1.1 Ramp passed the test (either 1:12 or 1:20 gradient) Yes No
conducted through the Simplified Gradient Finder
8.1.1.2 With provision of special assistance Yes No
8.1.2 Other forms of special support or conditions
8.1.2.1 Ground level entrance or exit Yes No Yes No
8.1.2.2 Dropped curb at the entrance or exit Yes No Yes No
8.1.2.3 Special lift or elevator Yes No Yes No
8.1.2.4 Facility or building catering to all PWD-related Yes No Yes No
concerns or services
8.1.2.5 The building is declared historical. Yes No Yes No
8.1.2.6 The building is under construction. Yes No Yes No
8.1.3 Toilet(s) for PWDs with L-shaped grab bars Yes No Yes No
8.2 City/Municipal Hospital/Main Health Facility/Rural Health Unit
8.2.1 Ramp with handrails at the entrance or exit Yes No Yes No
If yes (for RAT members):
8.2.1.1 Ramp passed the test (either 1:12 or 1:20 gradient) Yes No
conducted through the Simplified Gradient Finder
8.2.1.2 With provision of special assistance Yes No
8.2.2 Other forms of special support
8.2.2.1 Ground level entrance or exit Yes No Yes No
8.2.2.2 Dropped curb at the entrance or exit Yes No Yes No
8.2.2.3 Special lift or elevator Yes No Yes No
8.2.2.4 Facility or building catering to all PWD-related Yes No Yes No
concerns or services
8.2.2.5 The building is declared historical. Yes No Yes No
8.2.2.6 The building is under construction. Yes No Yes No
8.2.3 Toilet(s) for PWDs with L-shaped grab bars Yes No Yes No
Additional Observation or Information from RAT Members:
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Department of the Interior and Local Government
Form CM 2.3
Assessment for the Seal of Good Local Governance
Social Protection
CY 2016
9 (N) The LGUs Indigenous People mandatory representative has been issued Yes No Yes No
with a Certificate of Affirmation by the NCIP Regional Office.
(If item is not applicable, indicate NA here: __________)
If yes, indicate if the following conditions are observed:
9.1 IPMR seats in the sanggunian. Yes No Yes No
9.2 IPMR receives compensation and other regular benefits of a Yes No Yes No
Sanggunian Member.
9.3 IPMR attends sanggunian sessions as indicated in the Minutes of the Yes No Yes No
Meetings.
Additional Observation or Information from RAT Members (tick as appropriate):
Discrepancy in LGU and NGA data; with accomplished Change Request Form
No discrepancy in LGU and NGA data
11 The LGU implemented social-protection related programs for sectoral Yes No Yes No
concerns for CY 2015.
If yes, indicate if the LGU implemented at least 2 programs for cities or at
least 1 program for municipalities for the following sectors (based on Form
CM 2.3B):
11.1 Children and youth Yes No Yes No
11.2 Women Yes No Yes No
11.3 Persons with Disabilities Yes No Yes No
11.4 Senior citizens Yes No Yes No
11.5 Family and community Yes No Yes No
11.6 Internally-displaced persons and communities Yes No Yes No
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Department of the Interior and Local Government
Form CM 2.3
Assessment for the Seal of Good Local Governance Social Protection
CY 2016
Collected by:
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Department of the Interior and Local Government
Form CM 2.3A
Assessment for the Seal of Good Local Governance Social Protection-Related Programs
CY 2016
CERTIFICATION
The barangays submitted quarterly reports of cases filed to them related to violence against
women and children.
Accordingly, ________ % of barangays provided complete quarterly (1st to 4th quarters) reports
for 2015.
In particular, here are the programs carried-out by the LGU (please tick programs per sector):
Certified by : Noted by :
LSWDO C/MLGOO
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Department of the Interior and Local Government
Form CM 2.3A
Assessment for the Seal of Good Local Governance Social Protection-Related Programs
CY 2016
Certified by : Noted by :
LSWDO C/MLGOO
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Department of the Interior and Local Government Form CM 2.3A
Assessment for the Seal of Good Local Governance Social Protection-Related Programs
CY 2016
This Certification is issued for the purpose of the Seal of Good Local Governance assessment.
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Department of the Interior and Local Government Form CM 2.3B
Assessment for the Seal of Good Local Governance Social Protection: Support to Education
CY 2016
CERTIFICATION
This is to certify that the Local School Board (LSB) Plan for CY 2015 of the City/Municipality of
_____________________ is aligned with the School Improvement Plan of the Department of Education.
As a proof, I affixed my signature in the 2015 LSB Plan.
Accordingly, here is the status of the 2015 plan implementation (Please supply required data):
This Certification is issued for the purpose of the Seal of Good Local Governance assessment.
Certified By:
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Department of the Interior and Local Government
Assessment for the Seal of Good Local Governance Form CM 2.4
Business Friendliness and Competitiveness
CY 2016
OR
2 The LGU supports local economic and investment promotion. Yes No Yes No
If yes, kindly indicate mechanism installed by the LGU (tick one answer
only):
Office for local economic and investment promotion Yes
Designated Officer for local economic and investment promotion Yes
Additional Observation or Information from RAT Members:
3 The LGU has a Citizens Charter for securing permits for new business and Yes No Yes No
business renewal.
If yes, kindly indicate if the following are specified in the Charter:
2.1 Application for new business permits has five steps or less. Yes No Yes No
2.2 Application for renewal of business permits has five steps or less. Yes No Yes No
Additional Observation or Information from RAT Members:
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Department of the Interior and Local Government
Form CM 2.4
Assessment for the Seal of Good Local Governance Business Friendliness and Competitiveness
CY 2016
6 Data from business application forms are being tracked and summarized. Yes No Yes No
If yes, kindly indicate mode of recording (tick one answer only):
Manual Yes
Computerized or computer-aided Yes
Kindly provide data on the following:
6.1.1 Number of new businesses
Collected by:
Verified and Certified by: All Members of the Regional Assessment Team:
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Department of the Interior and Local Government Form CM 2.4A
Assessment for the Seal of Good Local Governance Business Permit Transaction Samples
CY 2016
City/Municipality of : Region :
Province :
INSTRUCTIONS
For the C/MLGOO:
(1) Ask the BPLO for the month and day of the previous year with the highest volume of transaction for business permits for both new and
renewal.
(2) Review database, record book or copy of application forms.
(3) Get sample transactions, at least 50% each for new business and renewal. Maximum number of samples for each is 100.
(4) Record the samples and their processing time.
Sample Transactions:
Signature over Printed Name of C/MLGOO Signature over Printed Name of BPLO
Date: Date:
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Department of the Interior and Local Government Form CM 2.5
Assessment for the Seal of Good Local Governance Peace and Order
CY 2016
2 The LGU has adopted a Local Anti-Criminality Action Plan for CY 2015 Yes No Yes No
(whether a separate plan or embodied in the Integrated Area Community
Public Safety Plan or Local Peace & Order, and Public Safety Plan).
If yes, indicate if the plan attained at least (based on Form CM 2.5A):
2.1 75% completion rate Yes No Yes No
2.2 75% utilization rate of fund allocation Yes No Yes No
Additional Observation or Information from RAT Members:
3 The LGU has provided logistical support to the PNP City/Municipal Police Yes No Yes No
Station or Office for CY 2015 (based on Form 2.5A).
If yes, logistical support was provided in and/or utilized until the:
3.1 3rd quarter, CY 2015 Yes No Yes No
3.2 4th quarter, CY 2015 Yes No Yes No
Additional Observation or Information from RAT Members:
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Department of the Interior and Local Government Form CM 2.5
Assessment for the Seal of Good Local Governance Peace and Order
CY 2016
Collected by:
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Department of the Interior and Local Government Form CM 2.5A
Assessment for the Seal of Good Local Governance Peace and Order
CY 2016
CERTIFICATION
The City/Municipal Mayor convened in CY 2015 the Local Peace and Order Council (LPOC).
In particular, the LPOC met at least once in the:
The LGU has adopted a Local Anti-Criminality Action Plan for CY 2015 (whether a separate
plan or embodied in the Integrated Area Community Public Safety Plan or Local Peace &
Order, and Public Safety Plan).
Accordingly, here is the status of the 2015 plan implementation (please supply required data.):
The LGU has provided logistical support to the PNP Local Police Office/Station in CY 2015.
Accordingly, the following are the forms of support given (please tick applicable choices only):
Ammunition Police Station
Communication Supplies
Vehicle Others (please specify):
_________________________________
Certified by : Noted by :
Local PNP Chief C/MLGOO
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Department of the Interior and Local Government Form CM 2.5A
Assessment for the Seal of Good Local Governance Peace and Order
CY 2016
The LGU has supported the organization of the Barangay Peacekeeping Action Teams, or its
equivalent.
This Certification is issued for the purpose of the Seal of Good Local Governance assessment.
Issued this ___ day of ______________, 2016 at the PNP Police Office/Station,
___________________________________.
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Department of the Interior and Local Government Form CM 2.6
Assessment for the Seal of Good Local Governance Environmental Management
CY 2016
2 The LGU has a Materials Recovery Facility, at the minimum storage for Yes No Yes No
recyclable materials.
If yes, kindly indicate the type of storage facility:
2.1 LGU-managed Material Recovery Facility or similar facility Yes No Yes No
2.2 Through a partnership with similar entity e.g., junkshop Yes No Yes No
Additional Observation or Information from RAT Members:
3 The LGU has a Ten-Year Solid Waste Management Plan. Yes No Yes No
If yes, kindly indicate status (tick one answer):
The plan has been submitted for review to the NSWMC Yes
The plan is already approved by NSWMC. Yes
Additional Observation or Information from RAT Members for the approved SWM Plan (tick as appropriate):
Discrepancy in LGU and NGA data; with accomplished Change Request Form
No discrepancy in LGU and NGA data
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Department of the Interior and Local Government
Assessment for the Seal of Good Local Governance Form CM 2.6
Environmental Management
CY 2016
Collected by:
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