Department of the Interior and Local Government

Form CM 3.11
CY 2021 Seal of Good Local Governance Summary
(For Field Test Purposes Only)

Seal of Good Local Governance – DOCUMENTARY REVIEW & INITIAL ASSESSMENT

Summary of Initial Results

City/Municipality of : __________________________________ Income Class : ______

Province of : __________________________________ Region : ______

INSTRUCTIONS: PLEASE READ BEFORE PROCEEDING TO THE ITEMS.

(1) Based on the findings in Forms CM 3.1 – 3.10, please tick the appropriate box per indicator under Column 1. (2) Since there will be no change
request procedure during this field test, please leave Column 2 blank. (3) In case of a correction/erasure, affix signature parallel to corrected portion. (4)
Affix signature at the last page of this summary form, and put initials at the bottom of each page.

Column 2 Remarks
Column 1 With pending
Initial Processing change
Indicator request?
PASSED PASSED FAILED NA YES NO
REQUIREMENT CONSIDERATION

FINANCIAL ADMINISTRATION
1.1. Most recent COA Opinion is ☐ ☐ _____________
un/qualified plus 30% of
recommendations fully acted
upon
1.2. FDP compliance for CY 2020 all ☐ ☐ ☐ ☐ ______________
quarters and CY 2021 1st quarter
posting period (Three conspicuous
places, FDP Portal, and e-SRE
posting)
1.3. At least 5% increase in average ☐ ☐ ☐ ☐ ☐ ______________
local revenue growth for three
consecutive years (CYs 2017 to
2019)
1.4. Full utilization of 20% component ☐ ☐ ☐ ☐ ☐ ______________
of the 2019 IRA
Consideration: Passing benchmarks of at
least: Cities = 55%, and Municipalities =
66%
1.5. Full utilization of Performance ☐ ☐ ☐ ☐ ☐ ______________
Challenge Fund released in 2019
and earlier
1.6. Full utilization of Assistance to ☐ ☐ ☐ ☐ ☐ ______________
Municipalities fund released in
2018 and earlier and at least 85%
for CY 2019 funds
1.7. CY 2021 budget is approved by ☐ ☐ ☐ ______________
Dec. 31, 2020
Consideration: Passed budget by Mar.
31, 2021
Area Processing: Passed all of the ☐ N/A ☐ N/A N/A N/A ______________
applicable items from 1.1 to 1.7
DISASTER PREPAREDNESS
2.1 2019 Gawad KALASAG 1st Place ☐ ______________
National Awardee for Best
LDRRMC, or 2019 Hall of Fame
Awardee
2.2 Full LDRRMC membership and ☐ ☐ ☐ ______________
regular meetings for all quarters
CY 2020 and 1st quarter of CY
2021
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 Department of the Interior and Local Government
CY 2021 Seal of Good Local Governance
(For Field Test Purposes Only)

Column 2 Remarks
Column 1 With pending
Initial Processing change
Indicator request?
PASSED
REQUIREMENT
PASSED
CONSIDERATION
FAILED NA YES NO
Consideration: Convened only in 3rd and
4th quarter of CY 2020, and 1st quarter
of CY 2021
2.3 LDRRMO with: ☐ ☐ ☐ ______________
a) Plantilla Head with
prescribed SG (QC and Manila:
24, Other Cities: 22, 1st-3rd Mun: 18,
4th-6th Mun: 15);
b) Minimum number of Plantilla
staff complement (HUC: 3, CC
and 1st-3rd Mun: 1, 4th-6th Mun: 1);
Consideration: Designated staff
complement; and
c) Workspace
2.4 Approved CLUP ☐ ☐ ☐ ______________
Consideration: In case Plan is still under
review, risk assessment should have
been already incorporated in the FINAL
DRAFT.
2.5 LDRRM Plan and Budget ☐ ☐ ______________

2.6 Adopted LCCAP ☐ ☐ ______________

2.7 Contingency plan for top 2 high ☐ ☐ ______________

risk hazard
2.8 At least 50% fund utilization of ☐ ☐ ______________
the 70% component of CY 2020
LDRRMF (Current Fund; cut-off date:
Dec. 31, 2020)
2.9 At least 75% of brgys have ☐ ☐ ______________
CBDRRM Plans
2.10 Early warning system with: ☐ ☐ ______________
a) at least 1 marker for top 1
and top 2 hazard in high-risk
areas,
b) warning and alarm system,
c) automated or locally-
innovated rain gauge, and
d) information on EWS in
conspicuous places
2.11 Evacuation management with: ☐ ☐ ______________
a) evacuation center with
minimum required facilities,
b) system for registration,
c) prepositioned goods and
resources, and
d) 100% of brgys with info
guide
2.12 Standard Operating Procedures ☐ ☐ ______________
(SOP) for coordination and
monitoring of actions during
disasters:
a) SOP,
b) equipped and trained
SAR/ER teams,
c) Operations Center (HUC-
functioning 24/7,
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 Department of the Interior and Local Government
CY 2021 Seal of Good Local Governance
(For Field Test Purposes Only)

Column 2 Remarks
Column 1 With pending
Initial Processing change
Indicator request?
PASSED
REQUIREMENT
PASSED
CONSIDERATION
FAILED NA YES NO
CC/M-functioning during disasters),
d) ICS training, and
e) SOP – Pre-emptive and
forced evacuation)
For 4th-6th Municipalities: any two of
items c to e.
2.13 Participation in the CY 2021 ☐ ☐ ______________
Gawad Kalasag Seal
assessment
Area Processing: Passed all of the ☐ N/A ☐ N/A N/A N/A ______________
applicable items from 2.1 to 2.13
SOCIAL PROTECTION AND SENSITIVITY
3.2a GAD mechanisms: ☐ ☐ ☐ ______________
a) Focal point system,
b) Database,
c) 2020 Accomplishment
report,
d) GAD Code updated not
earlier than CY 2016,
e) CY 2021 plan and budget,
and
f) at least 75% utilization/
completion of CY 2019 GAD
budget
Consideration: GAD Code updated not
earlier than CY 2011
3.2b VAWC mechanism (Organized ☐ ☐ ☐ ______________
LCAT-VAWC, 100% of
barangays w/ VAWC desks, at
least 85% of barangays w/
submitted reports for all quarters
of CY 2020
Consideration: With submitted reports in
3rd and 4th quarter of CY 2020
3.3a Local Code for Children updated ☐ ☐ ☐ ______________
not earlier than CY 2016
Consideration: Code updated not earlier
than CY 2011
3.4a Compliance with Accessibility ☐ ☐ ☐ ______________
Law in:
a) LG building,
b) LG main hospital/main health
facility, and
c) one LG-managed tertiary
educational facility/technical
vocational education and
training center (if available)
3.4b Functionality of Persons with ☐ ☐ ☐ ______________
Disability Affairs Office (PDAO):
a) ordinance establishing
PDAO;
b) Permanent PDAO Head;
Consideration: HUC with PDAO
established
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 Department of the Interior and Local Government
CY 2021 Seal of Good Local Governance
(For Field Test Purposes Only)

Column 2 Remarks
Column 1 With pending
Initial Processing change
Indicator request?
PASSED
REQUIREMENT
PASSED
CONSIDERATION
FAILED NA YES NO
through an executive order;
provided that there is at least a
designated PWD affairs officer

AND any two of:

c) Accomplishment Report of
any PWD-related PPAs,
d) Mechanism for the issuance
of persons with disability IDs,
and
e) Uploading of data to the
DOH PRPWD
3.5 Established Senior Citizens ☐ ☐ ☐ ______________
Center
3.6 IPMR with COA, if applicable, is: ☐ ☐ ☐ ☐ ☐ ☐ ______________
a) seated in the Sanggunian,
b) receiving appropriate
compensation and other
regular benefits, and
c) attending Sanggunian
meetings.
3.7 Absence of illegal dwelling ☐ ☐ ☐ ☐ ______________
units/structures, OR LGU efforts
against informal settlements [For
Cities only]
Consideration: With an ordinance, task
force or similar entity and has an
approved Local Shelter Plan.
3.8 At least 75% fund utilization/ ☐ ☐ ______________
completion of PPAs in CY 2019
for each:
a) Senior citizen and PWDs,
and
b) LCPC (1% of IRA allocation)
3.9 Full utilization of funds for ☐ ☐ ☐ ☐ ☐ ☐ ______________
Salintubig/water project CY
2016-2018 (at least 50% for CY
2019) Note: Previous years’ releases
must also be fully utilized
3.10 DSWD-accredited LGU- ☐ ☐ ☐ ☐ ______________
managed residential care facility
for the vulnerable sectors [For
HUCs only]
Consideration: Existing partnership with
an accredited facility
3.11 Functional LSWDO: ☐ ☐ ☐ ______________
a) Registered LSWDO with
valid PRC license,
Consideration: LGU conditions
cited in technical notes
b) Targeting System for Poor
and Vulnerable Sectors and
Households, and
c) Manual of Operations or
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 Department of the Interior and Local Government
CY 2021 Seal of Good Local Governance
(For Field Test Purposes Only)

Column 2 Remarks
Column 1 With pending
Initial Processing change
Indicator request?
PASSED
REQUIREMENT
PASSED
CONSIDERATION
FAILED NA YES NO
local guidelines on a case
management system
3.12 Local policy on social protection ☐ ☐ ☐ ______________
adopted
3.13 Institutionalized Public ☐ ☐ ☐ ______________
Employment Service Office with
Permanent PESO Manager with
prescribed SG
Consideration: With designated PESO
Manager/ Focal Person
3.14 Functional LDC with: ☐ ☐ ☐ ______________
a) Appropriate composition;
b) Meetings (both semesters in
CY 2020);
c) all plans-CDP, LDIP and AIP;
and
d) satisfactory participation of
CSOs
Area Processing: Passed all of the ☐ N/A ☐ N/A N/A N/A ______________
applicable items from 3.2 to 3.14
HEALTH COMPLIANCE AND RESPONSIVENESS
4.1 Functional Local Epidemiology ☐ ☐ ☐ ☐ ______________
Surveillance Unit (LESU)
4.2 Complete Local Investment ☐ ☐ ☐ ☐ ______________
Plan for Health (LIPH)
4.3 Institutionalized DRMM-H ☐ ☐ ☐ ☐ ______________
system
4.4 Equal or below mean in stunting ☐ ☐ ☐ ☐ ______________
rate among children under-five
4.5 At least 47.5% of households ☐ ☐ ☐ ☐ ______________
with access to safely-managed
drinking water services
4.6 TB Case Notification Rate: CY ☐ ☐ ☐ ☐ ______________
2019 rate is equal to, or above
2018 accomplishment
4.7 TB Treatment Success Rate: CY ☐ ☐ ☐ ☐ ______________
2018 rate equal to, or above
2017 accomplishment
Area Processing: Passed at least ☐ N/A ☐ N/A N/A N/A ______________
four (HUC/ICC) or three (CC/Mun) of
items 4.1 to 4.7
SUSTAINABLE EDUCATION
5.1 LSB Functionality: ☐ ☐ ☐ ______________
a) appropriate composition,
b) convened at least once in a
month in the 3rd and 4th
quarters of CY 2020 and 1st
Quarter of CY 2021
Consideration: Met at least once in
3rd and 4th quarter of CY 2020,
and 1st quarter of CY 2021
and
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 Department of the Interior and Local Government
CY 2021 Seal of Good Local Governance
(For Field Test Purposes Only)

Column 2 Remarks
Column 1 With pending
Initial Processing change
Indicator request?
PASSED
REQUIREMENT
PASSED
CONSIDERATION
FAILED NA YES NO
c) at least 85% fund utilization
or completion of CY 2019
LSB Plan
BUSINESS-FRIENDLINESS AND COMPETITIVENESS
6.1a Finalist of 2020 PCCI’s Most ☐ ☐ ______________
Business-Friendly LGUs Award
6.1b Ranked among the Top 20 ☐ ☐ ______________
Cities/Municipalities in the 2020
Competitiveness Index
6.2 Established Local Economic ☐ ☐ ______________
Development and Investment
Promotions Office/Unit i.e., has
structure, organization and staff
(Mun: Designated LEDIPO)
6.3 Updated citizens charter ☐ ☐ ______________

6.4 Simplified Business Processing ☐ ☐ ______________

and Licensing System: (a) not
more than 3 steps, both for new
and renewal of business; (b) not
more than 1 day processing time
for business renewal; (c) not
more than 2 days processing for
new business; and (d) Business-
One-Stop-Shop (Cities: all year-
round, Mun: seasonal)
6.5 Computerized or computer-aided ☐ ☐ ______________
tracking system of economic
data: (a) no. of new business; (b)
no. of business renewal; (c)
amount of capital investment
derived from registered new
businesses; and (d) no. of
employees derived from
registered new businesses and
business renewals (HUC: all 4
data, ICC/CC and mun: at least
3)
6.6 Local investment and incentives ☐ ☐ ☐ ______________
code updated not earlier than
CY 2016 [For Cities only]
Consideration: Code updated not earlier
than CY 2011
Area Processing: Passed item 6.1a , ☐ N/A ☐ N/A N/A N/A ______________
6.1b or all items from 6.2 to 6.6

SAFETY, PEACE AND ORDER

7.3 Provided logistical support to ☐ ☐ ______________
local PNP office in CY 2020
7.4 Barangay peacekeeping action ☐ ☐ ______________
teams: 100% organized and
100% trained
7.5 Drug-free ☐ ☐ ______________

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 Department of the Interior and Local Government
CY 2021 Seal of Good Local Governance
(For Field Test Purposes Only)

Column 2 Remarks
Column 1 With pending
Initial Processing change
Indicator request?
PASSED
REQUIREMENT
PASSED
CONSIDERATION
FAILED NA YES NO
city/municipality or increase in
drug-cleared barangays
7.6 Designated firecracker zones ☐ ☐ ______________

Area Processing: Passed all items ☐ N/A ☐ N/A N/A N/A ______________
from 7.3 to 7.6
ENVIRONMENTAL MANAGEMENT
8.1 Convened local solid waste ☐ ☐ ______________
management board
8.2 No operating open and/or ☐ ☐ ☐ ______________
controlled dumpsite
Consideration: Closed dumpsite as of
CY 2020 with an approved
SCRP/efforts to craft SCRP, and
access to landfill
8.3 Approved 10-year solid waste ☐ ☐ ☐ ______________
management plan
Consideration: SWM Plan that is still
under review of NSWMC
8.4 Materials recovery facility ☐ ☐ ______________

8.5 Access to sanitary landfill ☐ ☐ ☐ ______________

Consideration: ongoing efforts to
construct SLF or has alternative
technology officially recognized by
DENR-NSWMC
Area Processing: Passed all (HUC); ☐ N/A ☐ N/A N/A N/A ______________
Or items 8.1 and 8.2, plus any two
from 8.3, 8.4, 8.5 (CC/Mun)
TOURISM, HERITAGE DEVELOPMENT, CULTURE AND THE ARTS
9.1 Permanent local tourism officer ☐ ☐ ☐ ______________

9.2 Tourist information and ☐ ☐ ☐ ______________

assistance center or desks
9.3 Tracking system of tourism data ☐ ☐ ☐ ______________
(at the minimum: tourist arrivals
and tourism enterprises)
9.4 Council for the promotion of ☐ ☐ ☐ ______________
culture and the arts
9.5 At least 75% utilization rate of ☐ ☐ ______________
the budget appropriated for the
conservation and preservation of
cultural property, CY 2019
9.6 Cultural property inventory ☐ ☐ ☐ ______________
updated not earlier than 2019,
adopted by the LGU, and
submitted to NCCA for review

Consideration: updated not earlier than

2019, and is yet to be adopted and
transmitted to NCCA for review.
9.7 Published narrative history ☐ ☐ ______________

Area Processing: Passed any two of ☐ N/A ☐ N/A N/A N/A ______________
9.1 to 9.3 (for LGUs where tourism is
a significant industry only), AND any
three of 9.4 to 9.7
YOUTH DEVELOPMENT
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 Department of the Interior and Local Government
CY 2021 Seal of Good Local Governance
(For Field Test Purposes Only)

Column 2 Remarks
Column 1 With pending
Initial Processing change
Indicator request?
PASSED
REQUIREMENT
PASSED
CONSIDERATION
FAILED NA YES NO
10.1. Functional local youth ☐ ☐ ______________
development council:
a) Structure,
b) Meetings, and
c) Trained members.
10.2. Established local youth ☐ ☐ ______________
development office- Met any
three of the following:
a) Designated officer,
b) Database of youth
organizations,
c) At least 50% utilization of
appropriated CY 2019
budget for youth
development, and
d) Provided TA in conduct of
training for SK and LYDC
members.
10.3. Local Youth Development Plan ☐ ☐ ☐ ______________
Consideration: Final draft that is
already submitted to LYDC for review
and approval
10.4. LGU support to youth ☐ ☐ ______________
development- Met any two of
the following:
a) Policy,
b) Facility, and
c) Completed PPA.
Area Processing: Passed any two of ☐ N/A ☐ N/A N/A N/A ______________
items 10.1 to 10.4

FINDINGS:

☐ Passed 2021 SGLG criteria based on document review

☐ Did not pass the 2021 SGLG criteria based on document review

REMARKS:

_______________________________________________________________________________________
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I hereby certify that the information shown above are true and correct.

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Department of the Interior and Local Government
CY 2021 Seal of Good Local Governance
(For Field Test Purposes Only)

_______________________________________________ ______________________________

Signature over Printed Name Place of Assignment

_______________________________________________ ______________________________

Position / Designation Date

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