SGLGB Form 4 (Checklist)

Identifying Information

Region : XI
Barangay : _________________________
Municipality : _______________
Province : ________________

SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY

Data to be Certified by the Municipal Local Government Operations Officer

Indicator
1 Level of compliance with
Barangay Full Disclosure
Policy (BFDP)
Remarks
Data Requirements
(indicate if no data)
 BFDP Compliance:
CY 2018, Q4 _________
 Presence of the BFDP Board

2 Functionality of the  BPOC Monitoring Form 2:

Barangay Peace & Order Functionality of the BPOC
Committee (BPOC) pursuant _______________________
to DILG MC #2008-101
3 Functionality of the  EO/Ordinance or similar
Barangay Anti-Drug Abuse issuance organizing the
Committee (BADAC) BADAC:
pursuant to DILG-DDB JMC Yes ______ No ______
#2018-101
 IEC on illegal drugs demand
reduction:
Yes ______ No ______

 Date of last meeting:

________________________

 Committee on Operations:
Yes ______ No ______

 Committee on Advocacy:
Yes ______ No ______

Certified by:

______________________ _____________________
MLGOO Date
SGLGB Form 4.1

Identifying Information

Region : XI
Barangay : _________________________
Municipality : _________________________
Province : Davao Oriental

SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY

Data to be Certified by the Municipal Budget Officer

(In coordination with the Municipal Accountant & Bookkeeper)

Remarks
Indicator Data Requirements
(indicate if no data)
1 Approval of the Annual  Budget approved & submitted
Budget to Municipal Budget Office
before December 31, 2017:
Yes ______ No ______

 Re-enacted Budget used for FY

2018:
Yes ______ No ______

2 Use of Barangay  Barangay Cashbook:

Cashbook (latest report) Yes ______ No ______

 Updated:
Yes ______ No ______

 With Bookkeeper:
Yes ______ No ______

 According to COA standards:

Yes ______ No ______

3 Submission of  Submitted on the 10th day of

Disbursement Vouchers every month:
Yes ______ No ______

 Every month but was late once

or twice:
Yes ______ No ______

 Monthly but was late 3-12 times

Yes ______ No ______
 Remarks
Indicator Data Requirements
(indicate if no data)
 1-11 times only:
Yes ______ No ______

4 Percentage increase in  Total amount collected from

local resources fees & charges, tax collection,
etc.

CY 2017: _________________
CY 2018: _________________

5 Posting of the citizen’s Citizen’s Charter with provisions

charter in the barangay on:
 Barangay certification
Yes ______ No ______

 Barangay Clearance
Yes ______ No ______

 Community Tax Certificate

Yes ______ No ______

 Barangay records, data & similar

documents
Yes ______ No ______

 Barangay facilities & properties

Yes ______ No ______

 Katarungang Pambarangay
Yes ______ No ______

 Citizen’s Charter with Vision &

Mission Statements:
Yes ______ No ______

 Citizen’s Charter with feedback

mechanism:
Yes ______ No ______

6 Establishment of a  Drop box:

feedback mechanism Yes ______ No ______

 Text messaging/e-mails/hotlines:
Yes ______ No ______

 Public Assistance & Complaints

Desk Officer:
Yes ______ No ______
 Remarks
Indicator Data Requirements
(indicate if no data)
7 Enactment of a Barangay  Barangay Tax Ordinance:
Tax Ordinance Yes ______ No ______

 Updated:
Yes ______ No ______

Certified by:

_____________________________ _____________________
Budget Officer Date
SGLGB Form 4.2

Identifying Information

Region : XI
Barangay : _________________________
Municipality : _________________________
Province : Davao Oriental

SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY

Data to be Certified by the Municipal Disaster Risk Reduction & Management Officer

Remarks
Indicator Data Requirements
(indicate if no data)
1 Functionality of the  Executive Order or similar
Barangay Disaster Risk issuance creating the BDRRMC:
Reduction & Management Yes ______ No ______
Committee (BDRRMC)
 Approved BDRRM Plan:
Yes ______ No ______

 Date of last meeting:

__________________________

2 Accomplishment rate of  (a) Total number of PPAs in the

the PPAs reflected in the CY 2018 BDRRM Plan: _______
BDRRM Plan or the
Community-based DRRM  (b) Total number of
Plan accomplished PPAs in the CY
2018 BDRRM Plan : _______

 N = b/a x 100

 Accomplishment rate: ________

3 Number of drills  Earthquake: ________

conducted (earthquake,
fire & others)  Fire: ________

 Others: ________
 Remarks
Indicator Data Requirements
(indicate if no data)
4 Establishment of an Early  Early Warning System:
Warning System Yes ______ No ______

 Linked to higher LGUs:

Yes ______ No ______

 Community is aware of the

Early Warning System:
Yes ______ No ______

5 Available functional  First aid kit:

disaster equipment Yes ______ No ______

 Flashlight with batteries:

Yes ______ No ______

 Two-way radio/mobile phone:

Yes ______ No ______

 Rescue vehicle/barangay patrol

Yes ______ No ______

 Generator set:
Yes ______ No ______

Certified by:

____________________________ ____________________
LDRRMO Date
SGLGB Form 4.3

Identifying Information

Region : XI
Barangay : _________________________
Municipality : _________________________
Province : Davao Oriental

SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY

Data to be Certified by the Barangay

Remarks
Indicator Data Requirements
(indicate if no data)
1 Compliance with the  Location of the BFDP Board:
Barangay Full Disclosure __________________________
Policy (BFDP)
2 Financial Any of the following:
accomplishments reported  Post-activity report re: conduct
during the Barangay of CY 2018 BAD contained
Assembly Day (BAD) therein report on financial
accomplishment; or
 Financial accomplishment
report; or
 State of Barangay Address
incorporated therein the report
on financial accomplishment:
a. 1st semester BAD
Yes ______ No ______

b. 2nd semester BAD

Yes ______ No ______

3 Display of disaster-related  Signages:

signages, markers and Yes ______ No ______
directional signs in
strategic locations  With instructions going to the
evacuation center:
Yes ______ No ______

 Location of signages:
____________________________
 Remarks
Indicator Data Requirements
(indicate if no data)
4 Establishment of an Evacuation Center:
Evacuation Center  Owned
Yes ______ No ______

 Designated
Yes ______ No ______

 Location of the Evacuation

Center:
___________________________

5 Organization of the  Executive Order or similar

Barangay Emergency issuance creating the Barangay
Search & Response Teams Search and Rescue Teams:
or similar entities Yes ______ No ______

 Date issued: _________________

 Total number of teams: _______

 Trainings conducted in the past

12 months:
Yes ______ No ______

 Title of trainings:

1. ________________________
2. ________________________
3. ________________________

6 Establishment of a Day  Day Care Center:

Care Center Yes ______ No ______

 Barangay Day Care Worker:

Yes ______ No ______

 Location of the Day Care Center

____________________________

7 Designation of priority  Signages pertaining to priority

lanes for the lanes:
disadvantaged sectors Yes ______ No ______

8 Registration of  With Kasambahay Desk

Kasambahay Yes ______ No ______

 List of regisrered Kasambahays

Yes ______ No ______
 Remarks
Indicator Data Requirements
(indicate if no data)
9 Percentage of cases  Total number of cases filed:
settled under the ____________
Katarungang
Pambarangay  Total number of cases settled:
____________

 Percentage of cases acted upon:

____________%

10 Maintenance of Record  Presence of RBI:

of Barangay Inhabitants Yes ______ No ______
(RBI) or similar document

Prepared by: Certified by:

_______________________ _______________________
Barangay Secretary Punong Barangay

Date: _________________
SGLGB Form 4.4

Identifying Information

Region : XI
Barangay : _________________________
Municipality : _________________________
Province : Davao Oriental

SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY

Data to be Certified by the Municipal Social Welfare & Development Officer

Remarks
Indicator Data Requirements
(indicate if no data)
1 Functionality of the  Ordinance or similar issuance
Violence Against Women creating the VAW Desk:
(VAW) Desk Yes ______ No ______

 VAW Desk Person trained:

Yes ______ No ______

 Submitted VAWC reports:

a. 1Q Yes _____ No _____
b. 2Q Yes _____ No _____
c. 3Q Yes _____ No _____
d. 4Q Yes _____ No _____

 Number of late submission of

reports: _____________

2 Participation rate of Day  Total number of children aged

Care attendance 2-3 years old: __________

 Total number of children aged

2-3 years old attending day
care: ____________

Certified by:

__________________________ ___________________
MSWDO Date
SGLGB Form 4.5

Identifying Information

Region : XI
Barangay : _________________________
Municipality : _________________________
Province : Davao Oriental

SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY

Data to be Certified by the Municipal Health Officer

Remarks
Indicator Data Requirements
(indicate if no data)
1 Accessibility to Health Executive Order or similar issuance
Care services in the appointing/designating the:
Barangay
 Barangay Health Worker
(BHW):
Yes ______ No ______

 Barangay Nutrition Scholar

(BNS):
Yes ______ No ______

 Location of the Barangay Health

Station/Center:
____________________________

Certified by:

_____________________________ _____________________
Municipal Health Officer Date
SGLGB Form 4.6

Identifying Information

Region : XI
Barangay : _________________________
Municipality : _________________________
Province : Davao Oriental

SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY

Data to be Certified by the Municipal Planning & Development Officer

Remarks
Indicator Data Requirements
(indicate if no data)
1 Functionality of the  Executive Order or similar
Barangay Development issuance creating the BDC:
Council (BDC) Yes ______ No ______

 Approved Barangay
Development Plan (BDP):
Yes ______ No ______

 Minutes of meeting:
Yes ______ No ______

 ¼ CSO membership:
Yes ______ No ______

2 Representation of CSOs in Executive Order or similar issuance

the Barangay Based creating the BBIs with CSO
Institutions ( representation:
 BDRRMC: Yes____ No____
 BDC: Yes____ No____
 BPOC: Yes____ No____
 BADAC: Yes____ No____
 BESWMC: Yes____ No____
 BCPC: Yes____ No____
 Barangay GAD Focal Point
System: Yes____ No____

3 Implementation of PPAs Approved BDP/AIP with PPAs for:

for the disadvantaged  Women: Yes____ No____
sectors  Children: Yes____ No ____
 Senior Citizens: Yes____ No____
 PWDs: Yes____ No____
 Remarks
Indicator Data Requirements
(indicate if no data)
4 Implementation of PPAs  Anti-illegal drugs prevention
on anti-illegal drugs PPAs in the Barangay
Development Plan/AIP:
Yes ______ No ______

Certified by:

___________________________ ____________________
MPDO Date
SGLGB Form 4.7

Identifying Information

Region : XI
Barangay : _________________________
Municipality : _________________________
Province : Davao Oriental

SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY

Data to be Certified by the Chief of Police

Remarks
Indicator Data Requirements
(indicate if no data)
1 Presence of Barangay  Regular patrol/ronda:
Tanods Yes ______ No ______

 Attended capacity building

activities/skills enhancement
training/seminar:
Yes ______ No ______

Certified by:

___________________________ _____________________
Chief of Police Date
SGLGB Form 4.8

Identifying Information

Region : XI
Barangay : _________________________
Municipality : _________________________
Province : Davao Oriental

SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY

Data to be Certified by the Municipal Environment & Natural Resources Officer

Remarks
Indicator Data Requirements
(indicate if no data)
1 Functionality of the MRF type:
Materials Recovery  Barangay-owned:
Facility (MRF) Yes ______ No ______

 Clustered:
Yes ______ No ______

Other materials recovery scheme:

 Solid waste transfer station or
sorting station:
Yes ______ No ______

 Drop-off center:
Yes ______ No ______

 Composting facility:
Yes ______ No ______

 Recycling facility:
Yes ______ No ______

2 Effectiveness of the “No  Ordinance or similar issuance on

Littering Rule” and other “No Littering Rule”:
Ordinance Yes ______ No ______

 Signages/markers on “No
Littering Rule”:
Yes ______ No ______ Yes
______ No ______

 Absence of litter and/or garbage

dumps in the barangay:
Yes ______ No ______
 Remarks
Indicator Data Requirements
(indicate if no data)
3 Presence of a collection  Ordinance or similar issuance on
system segregation of wastes-at-source:
Yes ______ No ______

4 Organization of the  Executive Order or similar

Barangay Ecological Solid issuance organizing the
Waste Management BESWMC:
Committee (BESWMC) Yes ______ No ______

 Approved Solid Waste

Management Program/Plan:
Yes ______ No ______

Certified by:

___________________________ _____________________
MENRO Date