Republic of the Philippines

Bangsamoro Autonomous Region in Muslim Mindanao

Ministry Of Basic, Higher and Technical Education
Cotabato City

SCHOOL BUILDING PROGRAM

PROJECT MANAGEMENT OFFICE

WASH FACILITY ASSESSMENT TOOL

Name of School: ___________________________ Name: _______________________________

Location: _____________________________ Contact No.: _________________________
Name of Division: __________________________ Agency / Position: _______________________

ANSWERS
No. Description QUESTIONS REMARKS
YES NO
I Hand Wash Facility
With Existing Concrete Group Hand Wash Facility?
Number of Existing Functional Concrete Group
Hand Wash Facility?
Number of Existing Non-Functional / Damaged
Concrete Group Hand Wash Facility?
Number of Existing Concrete Group Hand Wash
Facility with Roofing?
Number of Holes / Faucets in Each Existing
Concrete Hand Wash Facility?
II Site Selection
Easily Accessible to Beneficiaries / Students?
Flooded Area?
Adequate, Available & Buildable Space?
Land Ownership:
- Private, willing to donate?
- Public
Available Deed of Donation?
III Water Source
- Available Spring Source?
Distance of spring from school site (m)
Estimated elevation of spring (m)
- Available Tap Water?
- Potential Ground Source (well drilling)?
- Rain Water Source
Distance of Groundwater Source or Spring from
Potential Contaminants (septic tank, landfill or
cemetery)
Other sources of water in the area (specify):
IV Electricity Source
Solar Power?
On-grid Electrical Connection?
V Other Information
Available Source of Water?

Ground Floor, RELC Bldg., MBHTE Regional Office, Bangsamoro People’s Compound, Rosary Heights 7, Cotabato City Email:
pmo.mbhtebarmm@gmail.com Contact Number: 0955-461-4753
 Republic of the Philippines
Bangsamoro Autonomous Region in Muslim Mindanao
Ministry Of Basic, Higher and Technical Education
Cotabato City

SCHOOL BUILDING PROGRAM

PROJECT MANAGEMENT OFFICE
Access to Electricity?
Available Network Signal (Smart/Globe)?
Available Mobile Internet Signal?
Available Satellite Signal (GPS)?
Stable Peace and Order?
VI School Details
Estimated Number of Students?
Estimated Ratio of Male to Female Students?
Number of Persons with Disability (PWD)?
Number of Existing Classrooms?
Estimated Land Area / Dimensions of the School
Campus?
VII Area Situation
(Issues, Concerns,
Recommendation)

Site Development Plan

Validated By:____________________________
(Name, Signature and Date)
Ground Floor, RELC Bldg., MBHTE Regional Office, Bangsamoro People’s Compound, Rosary Heights 7, Cotabato City Email:
pmo.mbhtebarmm@gmail.com Contact Number: 0955-461-4753