Republic of the Philippines

Department of the Interior and Local Government

[Address of DILG Regional Office]

(FOR BRIDGE)

Name of Bridge : _____________________________________________________

Length of Bridge : _____________________________________________________
Location of Bridge : _____________________________________________________
Date of Profiling : _____________________________________________________

Direction: Please check the appropriate box or, where relevant, specify your answer.

A. With Existing Bridge

1. Type of Bridge
Wooden Bridge (Timber Trestle)

Bailey Bridge (Steel/ Wooden Transom)

RCDG

Steel Bridge

Overflow Bridge

Others ________

REMARKS:___________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________

2. Condition of Bridge
For Replacement

For Repair

For Rehabilitation

For Improvement

REMARKS:___________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
 B. Without Bridge

Construction of New Bridge

1. Type of Bridge
Wooden Bridge (Timber Trestle)

Bailey Bridge (Steel/ Wooden Transom)

RCDG

Steel Bridge

Overflow Bridge

Others ________

Length: ______
Cost Per Unit of Measure (Linear Meter): ________

REMARKS:___________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________

NOTE:
1) For RROW, ownership of the land should be established prior to implementation.
2) The implementing unit is in charge in RROW acquisition including permit and clearances.
3) For new road opening, all necessary assessments shall be prepared by the implementing unit.

Evaluated by:

______________________ ______________________
Name and Position Name and Position

______________________ ______________________
Name and Position Name and Position

Approved by:

_____________________
DILG Provincial Director