Annex 1 Self Assessment Form

ANNEX 1
Republic of the Philippines

DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT
BARANGAY DEVELOPMENT COUNCIL FUNCTIONALITY ASSESSMENT

SELF - ASSESSMENT FORM
YEAR UNDER REVIEW: ____________
(to be filled-up by the barangay)
Region:
Province:
Instruction: Put a check () on the box that corresponds to the given questions
1 The BDC is organized/reconsitituted YES NO MEANS OF VERIFICATION

Sangguniang Barangay Resolution
Executive Order
Others: (Please Specify)
2 The BDC is organized/reconstituted within 100 YES NO MEANS OF VERIFICATION

days upon assumption to office Sangguniang Barangay Resolution
Date of organization/reconstitution: ______________ Executive Order
3 The BDC Executive Committee is constituted YES NO MEANS OF VERIFICATION

Sangguniang Barangay Resolution
Executive Order
Minutes of the meetings prepared by the Secretary
4 BDC sectoral or functional committees are YES NO MEANS OF VERIFICATION

organized Sangguniang Barangay Resolution
Executive Order
5 BDC membership is in accordance with YES NO MEANS OF VERIFICATION

prescribed members of Section 107 of RA 7160 Sangguniang Barangay Resolution
Number of members of BDC: _________ Executive Order
6 At least 1/4 of the members of the BDC are YES NO MEANS OF VERIFICATION
representatives for accredited NGO Sangguniang Barangay Resolution
Number of representative from Executive Order
accredited NGOs: _______________ Others: (Please Specify)
7 At least 40% of all the BDC members are composed YES NO MEANS OF VERIFICATION
of women pursuant to RA 9170 or the Magna Carta Sangguniang Barangay Resolution
of Women of 2009 Executive Order
Number of female BDC Members: ________________ Directory/Profile of BDC Members
Number of male BDC Members: _________________ Others: (Please Specify)
8 BDC members attended any related trainings YES NO MEANS OF VERIFICATION

or orientation at least once in the previous year Post-activity Report of the Training
Attendance Sheets
Certficate of Participation/Attendance
Photo documentation with date and time stamp
9 BDC conducts meeting at least twice a year YES NO MEANS OF VERIFICATION

Date of 1st semester meeting: _______________ Minues of the meetings
Date of 2nd semester meeting: _______________ Attendance sheets
10 BDC Executive Committee conducts meetings YES NO MEANS OF VERIFICATION

at least once every quarter Minues of the meetings
Date of 1stQ Meeting: __________ Attendance sheets
Date of 2ndQ Meeting: ________ Photo documentation with date and time stamp
Date of 3rdQ Meeting:__________ Agenda of the meeting with BDC related concerns
Date of 4thQ Meeting: __________ Others: (Please Specify)
11 Sectoral and Functional Committee Meetings YES NO MEANS OF VERIFICATION

are conducted Minues of the meetings
Attendance sheets
12 Barangay Development Plan is formulated YES NO MEANS OF VERIFICATION

Barangay Development Plan (BDP)
Resolution of the BDC approving BDP
Sangguniang Barangay Resolution adopting BDP
13 Sectoral plans are intgerated in the BDP YES NO MEANS OF VERIFICATION

Barangay Development Plan (BDP)
Integrated sectoral plans/BBI plans in the BDP
Resolution of Sectors/BBIs submitting the
plan to BDP
Resolution of BDC adopting the plans
Agenda of BDC meetings reflecting recommendations
from BBIs /sectoral committees members
14 Local Developmet Investment Program/Annual YES NO MEANS OF VERIFICATION

Investment Program is formulated LDIP/AIP
Resolution of the BDC approving AIP
Sangguniang Barangay Resolution adopting AIP
15 BDP is submitted to the City/Municipal level for YES NO MEANS OF VERIFICATION

inclusion in the CDP Transmittal Letter/Resolution of the BDC/SB
submitting the BDP to the city/municipality
Copy of the BDP with stamp received by
the city/municipality
16 Percentage of accomplished PPAs vis-à-vis PERCENTAGE MEANS OF VERIFICATION

targeted PPAs in the AIP 100% - 85% LDIP/AIP
Number of target PPAs: ________ 84% - 50% Accomplishment Report
Number of accomplished PPAs: ________ 49% - 25% Preject Status Report
Below 25% Others: (Please Specify)
17 Percentage of utilization of allocated budget PERCENTAGE MEANS OF VERIFICATION

Amount of annual budget: _____________ 100% - 85% Approved appropriations ordinance
Amount of utilized budget: _____________ 84% - 50% Financial Reports
49% - 25% Accomplishment Report
Below 25% Others: (Please Specify)
18 Submission of annual accomplishment report YES NO MEANS OF VERIFICATION

Narrative Accomplishment Report
Physical and Financial Reports
State of the Barangay Address presented
during Barangay Assembly Days
19 Voluntary participation of the residents in the YES NO MEANS OF VERIFICATION

implementation of barangay PPAs Certificate of Appreciation/Recognition
Photo Documentation
After-activity reports
Attendance sheets
20 Conduct of public hearing/barangay assemblies YES NO MEANS OF VERIFICATION

for public consultation Minutes of the meetings
Minutes of the barangay assembly days
Photo Documentation with date and time stamp
21 Attendance of CSOs to the regular meetings YES NO MEANS OF VERIFICATION

of the BDC Minutes of the meetings
Attendance sheets
22 Conduct of consultation meetings with various YES NO MEANS OF VERIFICATION

sectors Minutes of the meetings
Attendance sheets
23 Attendance of BDC members to the meetings/ YES NO MEANS OF VERIFICATION

consultation initiated by higher LGUs (P/C/M) Minutes of the meetings
Attendance sheets
Prepared by : Date accomplished: _____________
(Name and Signature of Punong Barangay)

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ANNEX 1

Republic of the Philippines

BARANGAY DEVELOPMENT COUNCIL FUNCTIONALITY ASSESSMENT

1 The BDC is organized/reconsitituted YES NO MEANS OF VERIFICATION

2 The BDC is organized/reconstituted within 100 YES NO MEANS OF VERIFICATION

3 The BDC Executive Committee is constituted YES NO MEANS OF VERIFICATION

4 BDC sectoral or functional committees are YES NO MEANS OF VERIFICATION

5 BDC membership is in accordance with YES NO MEANS OF VERIFICATION

8 BDC members attended any related trainings YES NO MEANS OF VERIFICATION

9 BDC conducts meeting at least twice a year YES NO MEANS OF VERIFICATION

10 BDC Executive Committee conducts meetings YES NO MEANS OF VERIFICATION

11 Sectoral and Functional Committee Meetings YES NO MEANS OF VERIFICATION

12 Barangay Development Plan is formulated YES NO MEANS OF VERIFICATION

13 Sectoral plans are intgerated in the BDP YES NO MEANS OF VERIFICATION

14 Local Developmet Investment Program/Annual YES NO MEANS OF VERIFICATION

15 BDP is submitted to the City/Municipal level for YES NO MEANS OF VERIFICATION

16 Percentage of accomplished PPAs vis-à-vis PERCENTAGE MEANS OF VERIFICATION

17 Percentage of utilization of allocated budget PERCENTAGE MEANS OF VERIFICATION

18 Submission of annual accomplishment report YES NO MEANS OF VERIFICATION

19 Voluntary participation of the residents in the YES NO MEANS OF VERIFICATION

20 Conduct of public hearing/barangay assemblies YES NO MEANS OF VERIFICATION

21 Attendance of CSOs to the regular meetings YES NO MEANS OF VERIFICATION

22 Conduct of consultation meetings with various YES NO MEANS OF VERIFICATION

23 Attendance of BDC members to the meetings/ YES NO MEANS OF VERIFICATION

Prepared by : Date accomplished: _____________

(Name and Signature of Punong Barangay)

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