ANNEX C

Department of Education
School Building Inventory Form
(as of ____________)

Region: III-CENTRAL LUZON School ID:

Division: TARLAC PROVINCE School Name:

Table 1. Summary of Existing Building/Structure

Year Completed Building/Structure
Building/ Number of
Fund Specific Fund Building/Structure Number of Classification of Dimension
Structure Building/Structure Type Rooms by (if not (in meters)
Source/s Source/s Condition Storeys Building/structure
Number Design/Intent provided, refer to
building type) Width Length
Col.1 Col.2 Col.3 Col.4 Col.5 Col.6 Col.7 Col.8 Col.9 Col.10 Col.11

Prepared by: Certified True and Correct by: Validated by:

MARIA TERESA Y. AGLIAM

School Property Custodian School Head Schools Division Office Planning Officer III
 HAROLD J. PONTECHA
Schools Division Office Engineer III
 ANNEX D
Department of Education
School Building Inventory Form
(as of )

Region: III-CENTRAL LUZON School ID:

Division: TARLAC PROVINCE School Name:

Table 2. Existing Rooms per Building

Room Dimension
Building/ Have Undergone major (in
Number of Concurrent
Structure Room Number Room Condition repair for the last 5 years Actual Usage/s meters)
Usage/s
Number (Yes/No) Width Length
Col.1 Col.2 Col.3 Col.4 Col.5 Col.6 Col.7 Col.8

Prepared by: Certified True and Correct by: Validated by:

MARIA TERESA Y. AGLIAM

School Property Custodian School Head Schools Division Office Planning Officer III

HAROLD J. PONTECHA
Schools Division Office Engineer III
 ANNEX E
Department of Education
School Building Inventory Form
(as of )

Region: III-CENTRAL LUZON School ID:

Division: TARLAC PROVINCE School Name:

Table 3.Existing Number of Water Facilities and Sanitation Facilities

Building/ Number of Functional Toilet Bowls Number of Number of Number of Faucets

Number of Number of With Septic
Structure Non-Functional Sink/ With Water Without Water
Male Female PWD Shared Urinals Urinal Trough Tank (Yes/No)
Number Toilets Bowls Washbasin Supply Supply
Col.1 Col.2 Col.3 Col.4 Col.5 Col.6 Col.7 Col.8 Col.9 Col.10 Col.11 Col.12

Prepared by: Certified True and Correct by: Validated by:

MARIA TERESA Y. AGLIAM

School Property Custodian
School Head Schools Division Office Planning Officer III

HAROLD J. PONTECHA
Schools Division Office Engineer III
 ANNEX F
Department of Education
School Building Inventory Form
(as of )

Region: III-CENTRAL LUZON School ID:

Division: TARLAC PROVINCE School Name:

Table 4 .Existing Number of Usable Furniture

Building/ Kinder Science Science

Kinder Arm School Workshop Monoblock Monoblock Clasrrom Clasrrom Behavioral Teacher's Teacher's
Structure Modular Laboratory Laboratory
Chair Chair Desk Table Chair Stool Table Chair Chair Table Chair
Number Table Table Stool
Col.1 Col.2 Col.3 Col.4 Col.5 Col.6 Col.7 Col.8 Col.9 Col.10 Col.11 Col.12 Col.13 Col.14 Col.15

Prepared by: Certified True and Correct by: Validated by:

MARIA TERESA Y. AGLIAM

School Property Custodian School Head Schools Division Office Planning Officer III

HAROLD J. PONTECHA
Schools Division Office Engineer III
 ANNEX G
Department of Education
School Building Inventory Form
(as of )

Region: III-CENTRAL LUZON School ID:

Division: TARLAC PROVINCE School Name:

Table 5 .Other Facilities

Present in Campus?
Other Facilities
(Yes/No)
Col. 1 Col. 2
Concrete Quadrangle Yes No

Entrance Gate Yes No

Perimeter Fence Yes No

Play Ground Yes No

School Garden Yes No

Prepared by: Certified True and Correct by: Validated by:

MARIA TERESA Y. AGLIAM

School Property Custodian School Head Schools Division Office Planning Officer III

HAROLD J. PONTECHA
Schools Division Office Engineer III