2021 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY SGLGB Form No.

1
Assessment Period: CY 2019
Data Capture Form

Identifying Information

Region : 3
Barangay : Camposanto I Norte
City/Municipality : Moncada
Province : Tarlac

CORE AREA 1: SAFETY, PEACE AND ORDER

INDICATORS DATA DATA HOW TO ASSIGN PASSIN SCORE DOCUMENT

REQUIREMENTS SOURCE DETERMINE THE ED G OBTAIN SUBMITTED
SCORE SCORE ED BY
SCORE
THE
BARANG
AY
1. Functionality of the  Functionality of Barangay If the result is: 8 4 8 - BADAC 2019
Barangay Anti-Drug BADAC based Secretary Functionality
● High = 8
Abuse Council on DILG-DDB Assessment
(BADAC) JMC No. 2018- ● Moderate = 4
(DILG-DDB
01 DILG
● Low = 2 JMC 2018-01)
 Form 5 of DILG City/Municipal
MC No. 2018- Office ● No data = 0
135
- Form 5 of
DILG MC No.
2018-135

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 2021 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY SGLGB Form No. 1
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2. Functionality of the BPOC Monitoring DILG If the result is: 5 4 5 BPOC

Barangay Peace and Form No. 2 based City/Municipal Monitoring
● High = 5
Order Committee on DILG MC No. Office Form No. 2
(BPOC) 2020-047 ● Moderate = 4 based on DILG
MC No. 2020-
● Low = 3 047
● Non functional =
1
● No BPOC= 0
● No data = 0
3. Performance Rate in LTIA Form 003 DILG If the result is: 4 2 4 LTIA Form 003
the Lupong based on DILG MC City/Municipal based on DILG
● 85-100 = 4
Tagapamayapa No. 2016-58 Office MC No. 2016-
Incentives Awards ● 80-84 = 3 58
(LTIA)
● 75-79 = 2
● Below 75 = 1
● No data = 0
4. Maintenance of RBI form A of DILG Barangay ● With RBI = 1 1 1 1 RBI form A of
Record of Barangay MC No. 2008-144 Secretary DILG MC No.
● Without RBI = 0
Inhabitants (RBI) validated by the 2008-144
Punong Barangay
Date of last update:
June 30, 2021

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 2021 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY SGLGB Form No. 1
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5. Professionalizing EO or similar Barangay With EO or similar 1 1 1 Certification

the Barangay Tanod issuance on the Secretary issuance: from the
based on DILG MC organization of the Punong
Yes = 1
No. 2003-42 Barangay Tanod Barangay
No = 0

Training attended With trainings 1 1 1 Confirmation

for CY 2019 attended: Slip and
Certificates of
Yes = 1
Attendance
No = 0
TOTAL 20 13 20

CORE AREA 2: FINANCIAL ADMINISTRATION AND SUSTAINABILITY

INDICATORS DATA REQUIREMENTS DATA HOW TO PERFECT PASSING SCORE DOCUMENT

SOURCE DETERMINE SCORE SCORE OBTAINED SUBMITTED
THE SCORE BY THE
BARANGA
Y
1. Compliance  BFDP Monitoring Form DILG Presence of 2 2 2 BFDP
with the 1 , Form 2 and Form 3 City/Municipal BFDP Board Monitoring
Barangay Full pursuant to DILG MC Office Form 1 ,
● Yes = 2
Disclosure No. 2014-81 Form 2 and
Form 3
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 2021 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY SGLGB Form No. 1
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Data Capture Form

Policy (BFDP) ● No = 0 pursuant to

DILG MC No.
 Barangay Full
2014-81
Disclosure Board in
compliance to the
requirements set in,
Onsite Compliance to 3 3 3 Barangay Full
with photo
Inspection the design Disclosure
documentation
pursuant to Board in
Annex 7 of the compliance to
DILG MC No. the
2014-81: requirements
CY 2019, 4th Qtr set in, with
● Yes = 3
compliance: January 6, photo
2020 ● No = 0 documentatio
n

Location of the BFDP

Board: Camposanto I Norte If the result of CY 8 6 8 2019
Barangay Hall, Reading 2019, 4th Qtr Barangay
Center, Purok Sampaguita compliance is: Budget,
Waiting Shed Summary of
● Full
Income and
Compliance -
Expenditure,
8 financial
20%
documents
Component
(refer to
of IRA
technical
Utilization,
notes) = 8
Annual
● Partial Procurement
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 2021 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY SGLGB Form No. 1
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Compliance: Plan, List of

Notices of
o 7 financial
Award,
documents Itemized
posted = 7 Monthly
o 5-6 financial Collections
documents and
posted = 6 Disbursement
s
o 3-4 financial
documents
posted = 4
o 1-2 financial
documents
posted = 2
● Non-
compliance =
0
● No data = 0
2. Percentage Barangay Budget Barangay With increase? 3 3 - Barangay
Increase in Preparation Form No. 2: Treasurer Budget
● Yes = 3
local Actual Income and Preparation
resources Expenditure ● No = 0 Form No. 2:
Actual
Income and
Total amount collected Expenditure
from fees and charges:
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 2021 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY SGLGB Form No. 1
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City/Municipal
Accountant
CY 2018 PhP ________ - Certification
from the
CY 2019 PhP ________
Budget
Officer

Difference : PhP
_________
Percentage increase:
_____
3. Conduct of Monitor report on the Barangay Conducted 4 4 4 Report on the
Barangay compliance of the Secretary Barangay conduct of
Assembly for barangays to conduct Assembly: barangay
the first and barangay assembly to be assembly
1st Semester = 2
second submitted thru shared
semester of google drive 2nd Semester = 2
CY 2019
No data = 0
TOTAL 20 18

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CORE AREA 3: DISASTER PREPAREDNESS

INDICATORS DATA DATA HOW TO ASSIGN PASSIN SCORE DOCUMENT

REQUIREMENTS SOURCE DETERMINE THE ED G OBTAINE SUBMITTED
SCORE SCORE D BY THE
SCORE
BARANG
AY
1. Functionality of the 5% BDRRM Fund in Barangay With at least 5% 2 2 2 - 5% BDRRM
Barangay Disaster the Barangay : PhP Secretary/ BDRRM Fund fund in the
Risk Reduction and 108,224.30 Barangay allocation Annual Budget
Management Treasurer
● Yes = 2
Committee
(BDRRMC) To compute % ● No = 0
allocation for Local Disaster
LDRRMF: Risk Reduction
and
(BDRRMF Allocated Management
/ Estimated Total Officer
Revenue from (LDRRMO)
Regular Sources) x
100

EO or similar Organization of the 1

issuance creating BDRRMC
the BDRRMC
● Yes = 1
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● No = 0
● No data = 0 1 1
Approved Barangay With Approved 2 - EO creating
Disaster Risk BDRRM Plan the BDRRMC
Reduction and
● Yes, using the
Management
prescribed
(BDRRM) Plan
template = 2
under NDRRMC
Memorandum ● No = 0
Circular No. 01, - Approved
Series of 2018 2 2
BDRRM Plan

Minutes of the Conduct of quarterly 2

quarterly meeting meeting
● 4 out of 4 = 2
● 2 or 3 out of 4 =
1
● 1 out of 4 = 0
● No = 0
● No data = 0
Utilization Rate of Utilization of the 1 - Minutes of
the 70% component 70% BDRRM Fund 1 2 the quarterly
of the BDRRM Fund meeting
● 50% and above

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=1
To compute for % ● Less than 50% =
utilization: 0.5

% utilization of the ● No = 0
70% BDRRMF = ● No data = 0
(Total Amount
Utilized / Total
Amount Allocated) x
100 Accomplishme
nt Report
1 1

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● Accomplishment Barangay Accomplishment 3 2 3 Accomplishme

Report Secretary Rate of the nt Report
Activities/Projects
Reflected in the
How to compute? Local Disaster Barangay Disaster
Risk Reduction Risk Reduction and
Accomplishment Management Plan
and
A (BDRRMP)
rate = x 100 Management
B
Officer
● 60% and above
(LDRRMO)
=3
o A = Total number ● 40 – 59% = 2
of
activities/projects ● 20 – 39% = 1
accomplished in ● 19% and Below
the BDRRM plan =0
● No BDRRM Plan
o B= Total number =0
of
activities/projects
in the BDRRM
Plan
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2. Extent of risk Date of drill/s Barangay With Post-Activity 1 1 1 - Post Activity

assessment and conducted: Secretary Report: Report
Early Warning
February 21, 2019 ● Yes = 1
System (EWS)
October 25, 2019 Local Disaster ● No = 0
Risk Reduction
Drills conducted Conducted drills 1 1 1
and
(Earthquake, fire,
Management ● Earthquake/Fire/
etc.)
Officer Others = 1
(LDRRMO)
● No = 0
Local risk map Presence of Local 1 1 1
risk map
● Yes = 1
● No = 0 - Local Risk
Map
Early Warning Presence of Early 1 1 1
System (EWS) Warning System
location:
● Yes = 1
Camposanto I Norte
Barangay Hall and ● No = 0
Public Plaza - Early
Warning
System
3. Extent of EO or similar Barangay With EO or similar 1 1 1 Executive
preparedness for issuance creating Secretary issuance creating Order
effective response Barangay the Barangay
Emergency Search Emergency Search
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and recovery and Rescue Team/s Local Disaster and Rescue Team/s
Risk Reduction
● Yes = 1
and
Total number of Management ● No = 0
Emergency Search Officer
and Rescue (LDRRMO)
Team/s: 10 Provision of training 1 1
to the Emergency
1 - Certificates
Search and Rescue
of Participation
Team/s:
● Trained in the
past 12 months
(CY 2019) = 1
No training in the
past 12 months (CY
2019) = 0
Designated/Evacuat Presence of 1 1 1
ion Center location : Evacuation
Center/Designated
Camposanto I Norte
Evacuation Center
Barangay Hall
● Yes = 1
● No = 0
Disaster equipment: Disaster equipment 2 1 2 - Certification
● 2-way radio / ● 2-way radio / from the
mobile phone mobile phone = LDRRMO

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 2021 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY SGLGB Form No. 1
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● Rescue 0.5
vehicle/Baranga
● Rescue
y patrol
vehicle/Baranga
● Generator set y patrol = 0.5
● First aid kit ● Generator set =
0.5 - Photo
● Flashlight with
Documentatio
batteries ● First aid kit /
n
Flashlight with
batteries = 0.5
TOTAL 20 17

ESSENTIAL AREA 1: SOCIAL PROTECTION AND SENSITIVITY

INDICATORS DATA REQUIREMENTS DATA HOW TO ASSIGNED PASSING SCORE DOCUMENT

SOURCE DETERMINE SCORE OBTAINED SUBMITTED
SCORE
THE SCORE BY THE
BARANGA
Y
1. Functionality of Functionality of the Barangay If the result is: 1 1 1 - EO
the Violence Violence Against Secretary Creating the
● Ideal = 1
Against Women Women (VAW) Desk VAW Desk
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(VAW) Desk based on VAW Desk Local Social ● Mature = 0.5

Form 2 of MC No. 2017- Welfare and
● Basic -
114 dated 30 August Development
Progressive =
2017 Officer
0.25
● No
Functionality
=0
VAWC Cases Quarterly Submission of 2 1 2 - VAWC
Reports Quarterly Cases
Reports on Quarterly
● 1st Qtr submitted:
VAWC Cases Reports
April 05, 2019
● 1st Qtr report
● 2nd Qtr submitted:
submission =
July 8, 2019
0.5
● 3rd Qtr submitted:
● 2nd Qtr report
October 7, 2019
submission =
● 4th Qtr submitted: 0.5
January 8, 2019
● 3rd Qtr report
submission =
0.5
● 4th Qtr report
submission =
0.5
Certificate of VAW Desk 1 1 1 - Certificate
Attendance/Participation Person is trained of
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and Date of ● Yes = 1 Attendance/

Training/Seminar: Liga Participation
● No = 0
Congress on September of
25-27, 2019 Training/Se
minar

2. Access to EO or similar issuance Barangay Presence of EO 1 1 1 Appointment

health and on the Appointment of Secretary or similar of Barangay
social welfare Barangay Health Worker issuance on the Health
services in the (BHW) appointment of Workers
barangay On-site BHW (BHWs)
inspection
● Yes = 1
● No = 0
EO or similar issuance Presence of EO 1 1 Appointment
on the appointment of or similar of Barangay
Barangay Nutrition issuance on the Nutrition
Scholar (BNS) appointment of Scholar
BNS 1 (BNS)
● Yes = 1
● No = 0
Barangay Health Presence of a 1 1 Certification
Station/Center (BHS/C) BHS/C from the
MHO
Location: ● Maintained
BHS/C = 1
RHU II Rizal, Moncada
● With access
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BHS/C (check the to other

corresponding answer) BHS/C = 0.5
.50
____ Barangay ● None = 0
owned/maintained
Availability of 2 1 Certification
√ With access to other services in the from the
BHS/C BHS/C MHO
● Expanded
Program on
Immunization
(EPI) = 0.5
● Maternal
Care = 0.5
2
● Nutrition Care
= 0.5
● Other
Services =
0.5
● None = 0
3. Functionality of DILG-MC No. 2019-69 Punong If the result is: 1 1 1 - Annex 3
the Barangay Barangay (C/MAT
DILG MC No. 2019-112 ● High - Ideal =
Development Audit Form)
1
Council (BDC) ● Annex 3 (C/MAT
- Annex 4
Audit Form) Barangay ● Moderate =
(C/M
Secretary 0.5
● Annex 4 (C/M Consolidated

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Consolidated Results ● Low = 0.25 Results

Form) Form)
● Non-
Functional =
0.15
● None = 0
● No data = 0
2019 Barangay Bonus Point
Development Plan
With 2019
(BDP)
Barangay
Note: For 2019 assessment, Development
the BDP shall be crafted in Plan:
FY 2018 and shall cover the
period of 2018-2020. Also the Yes = 1
BDP in any format or - Barangay
template shall be considered No = 0 Development
and accepted Plan

1
5. Representation Ordinance or similar Barangay With EO or 1 1 1 - Executive
of CSOs in the issuance organizing Secretary similar issuance Order of 7
Barangay each of the following: organizing the BBIs
Based BBIs (with CSO
1. BDC
Institutions representative
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(BBIs) 2. BADAC that is accredited

by the
a. BDC 3. BDRRMC
Sangguniang
b. BADAC 4. BPOC Barangay):

c. BDRRMC 5. BESWMC ● 4 to 7 BBIs =

1
d. BPOC 6. BCPC
● 1-3 out of 7
e. BESWMC 7. Barangay GAD BBIs = 0.5
Focal Point System
f. BCPC ● No EO or
g. Barangay similar
GAD Focal CSO Assembly/Election issuance = 0
Point Report
System

6. Registration of DILG MC No. 2013-061 Barangay With established 2 2 1 - KR Form 5

Kasambahay Secretary kasambahay
● KR Form 5 –
and desk:
Barangay
Establishment
Consolidated Yes = 1
of Kasambahay Public
Kasambahay Report
Desk Employment No = 0
Note: If no Service
kasambahay /no Office
registered kasambahay Maintained and
in the barangay, indicate updated
the information in KR kasambahay
Form 5 masterlist KR
Form 5:

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Yes = 1
No kasambahay
registered = 1
No = 0
7. Functionality of DILG MC No. 2008-126 Barangay If the result is: 1 1 1 - LCPC Form
the Barangay Secretary 1-A
● LCPC Form 1-A ● Ideal = 1
Council for the
Protection of ● Mature = 0.5
Children (BCPC)
● Basic -
Progressive =
0.25
● No
Functionality
=0
8. Allocation for the PCW, DILG, DBM and Barangay With approved 1 1
Annual Gender NEDA JMC No. 2016-01 Secretary Barangay Annual
and Plan and Budget:
● Annex D-1
Development
Yes = 1
(GAD) Plan and
Budget No = 0
TOTAL 15 13

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ESSENTIAL AREA 2: BUSINESS-FRIENDLINESS AND COMPETITIVENESS

INDICATORS DATA DATA HOW TO ASSIGNED PASSING SCORE DOCUMENT

REQUIREMENTS SOURCE DETERMINE THE SCORE OBTAINED SUBMITTED
SCORE
SCORE BY THE
BARANGAY
1. Enactment of Barangay Tax Barangay Presence of 3 3 - Barangay
Barangay Tax Ordinance Secretary Barangay Tax
Ordinance Ordinance: Ordinance
● Presence of
Barangay Revenue Barangay
Barangay Tax
Code Treasurer
Ordinance = 3

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● No Barangay
Tax Ordinance
=0
2. Enactment of an Barangay Ordinance Barangay Presence of 3 3 - Barangay
ordinance Secretary Barangay Ordinance
relative to Ordinance:
Barangay
● Presence of
Clearance fees Barangay
Barangay
on business Treasurer
Ordinance = 3
permit and
locational ● No Barangay
clearance for Tax Ordinance
building permit =0
3. Approval of a Barangay Barangay Presence of 2 2
resolution Resolution Secretary Barangay
authorizing the Resolution:
City/Municipal
● Presence of
Treasurer to Barangay
Barangay
collect fees for Treasurer
Resolution = 2
Barangay
Clearance for ● No approved
Business permit Barangay
and locational Resolution = 0
clearance
purposes
4. Issuance of Logbook/record Barangay Timeliness of 7 5 7 Logbook
Barangay book Treasurer issuance of
Clearance1 within barangay
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seven (7) working clearance

days (for
● 90%-100% of
businesses
applications
which do not
met = 7
require
occupancy ● 80%-89% of
permits). For applications
locational met = 5
clearance,
issuance of ● 70%-79% of
Barangay applications
Clearance in not met = 3
more than three ● 60%-69% of
(3) working days applications
from application met = 2
at the
city/municipality ● 50%-59% of
applications
met = 1
● 49% and below
of applications
met = 0
TOTAL 15 13

1
Item 5.1 of DILG MC No. 2019-177 dated October 17, 2019 – Barangay Clearance refers to any and all documents issued by the barangays with or without
corresponding fees as defined in their ordinances relative to or in relation to the issuance of business permit and locational clearance by the city/municipality
or any other permit as may be required.
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ESSENTIAL AREA 3: ENVIRONMENTAL MANAGEMENT

INDICATORS DATA DATA HOW TO ASSIGNED PASSING SCORE DOCUMENT

REQUIREMENTS SOURCE DETERMINE THE SCORE OBTAINED SUBMITTED
SCORE
SCORE BY THE
BARANGAY
1. Presence of a ● MRF (check the Onsite Presence of MRF: 2 1 2 Photo
Materials corresponding inspection Documentati
● Yes = 2
Recovery answer) on
Facility (MRF) ● None but with
√ Barangay
pursuant to other materials
owned
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R.A. 9003 ____ Clustered recovery

Brgys scheme = 1
● None = 0
● Location of MRF
Purok Champaca
● MOA
● Certification from
the
City/Municipal
Environment and
Natural
Resources Office
(C/MENRO)
2. Presence of a  Ordinance or Barangay Presence of 2 2 2 -Certification
Collection similar issuance Secretary Ordinance on from the
System to on segregation- segregation of City/Municip
Ensure at-source wastes-at-source al
Segregation of Environment
● Yes = 2
Wastes at and Natural
Source  Certification from ● No = 0 Resources
the Office
City/Municipal (C/MENRO
Environment and
Natural
Resources Office

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(C/MENRO)
3. Functionality of EO or similar Barangay If the result is: 2 2 2 EO
Barangay issuance on the Secretary
EO organizing the
Ecological Solid organization of the
BESWMC
Waste BESWMC
Management ● Yes = 2
Committee
(BESWMC) ● No = 0
Approved Solid Approved 1 1 1 Approved
Waste Management BESWMC Solid Waste
Program/Plan Program/Plan Management
Plan
(Any template or ● Yes = 1
annotated)
● No = 0
Allocation of With fund 1 1
barangay funds, allocation:
approved by the
● Yes =1
sangguniang
barangay ● No = 0
Conduct of capacity- Capacity-building 2 2 2 Certificate of
building for activity conducted: Participation
BESWMC
Yes = 2
No = 0
TOTAL 10 9

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We certify to the correctness of the above information.

City/Municipal Assessment Team:

LGOO VI AIMEE L. TAVISORA

Chairperson

DR. GEORGE R. CUCHAPIN

Vice-Chairperson

RONILO D. BALGOS
Member

JIOLITO L. VALLEJOS
Member

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