Annex F – Activity Report/Minutes Form

Barangay/Community Activity Minutes Form

Region: ___________________________

Province: ___________________________

Municipality: ___________________________

Barangay/Community: ___________________________

Venue: ___________________________

Date: ___________________________

Total Brgy. Households _______ Total Families in the Brgy.____________

1. Activity Profile

Program/Project (e.g. NCDDP etc): _____________________

Activity Name: _______________________

Facilitator/s: _______________________

Documenter/Secretary: _______________________

2. Attendance

# marginalized representatives # of community group

Total Members at BDRRMC _______ _______ representatives ______

Households Represented _______ # of Pantawid HH _______ # of Pantawid Families ______

Male attendees _______ # of SLP HH _______ # of SLP Families ______

Female attendees _______ # of female-headed households _______

Male IP attendees _______ # of IP HH ______ # of IP Families ______

Female IP attendees _______

Male Attendees 60 years old and above _______

Female Attendees 60 years old and above _______

Purok/Sitios represented _______________________________________________________________________

Sectors represented ___________________________________________________________________________

Agenda/Objectives

___________________________________________________________________________________

Highlights of the activity including details of facilitation process and quality of participation of men and women during the
activity. (Attach the LGU prescribed minutes)
PINCOs and Grievances

Who raised the Concern and

PINCOs and Grievances Resolution/Next Steps/Agreements

Profile of the Person

e.g. Juan, IP member

Prepared by: Approved by:

______________________________ _________________________________

Signature over Printed Name Signature over Printed Name

______________________________ _________________________________

Position Position

Attachments (not limited to the following depending on the activity):

Attendance Sheet
Resolutions
Results/Outputs of the Activity (Copy of Plans)