Republic of the Philippines

Department of Education
REGION I
SCHOOLS DIVISION OF LA UNION

BRIGADA ESKWELA S.Y. ___________________

PHYSICAL FACILITIES AND MAINTENANCE NEEDS ASSESSMENT FORM

Instruction: Conduct an ocular inspection of the school physical listed below. Then provide the needed information to facilitate the improvement to be done
on these identified facilities. (If needed you may use separate forms for each classroom or school facility).

CONDITION Nature of
Remarks improvement
(Check One) Manpower Needed
Needed Material Resources
(Indicate quantity and
FACILITIES If Unsatisfactory, Needed (Indicate
(e.g. repair, nature of labor
Satisfactory Unsatisfactory describe the kind and quality)
repainting, services needed)
problem
replacement, etc)
Roofs/Gutters
Ceilings
Walls
Blackboards
Chairs/desks/tables
Water facilities/ Drainage
System
Signages
School garden
Lighting

Address: Flores St., Catbangen, City of San Fernando, La Union

Telephone No.: 205-0046
Email: la.union@deped.gov.ph
 Republic of the Philippines
Department of Education
REGION I
SCHOOLS DIVISION OF LA UNION

Windows
Doors
Comfort rooms
School grounds
School canteen/ clinic
School fence
Others, please specify:

Prepared by: Noted:

School Physical Facilities Coordinator Date of Inspection School Head/TIC/Head Teacher

Address: Flores St., Catbangen, City of San Fernando, La Union

Telephone No.: 205-0046
Email: la.union@deped.gov.ph