BE Form 01

Republic of the Philippines

Department of Education
Region I
SCHOOLS DIVISION II OF PANGASINAN
CALITLITAN ELEMENTARY SCHOOL
CALITLITAN UMINGAN PANGASINAN
School Year 2022-2023
BRIGADA ESKWELA
PHYSICAL FACILITIES AND MAINTENANCE NEEDS ASSESSMENT FORM
CONDITION Nature of improvement
Remarks Material Resources Manpower Needed(Indicate
(Check One) Needed
FACILITIES Needed (Indicate kind quantity and nature of
If Unsatisfactory, (e.g. repair, repainting,
Satisfactory Unsatisfactory and quality) labor services needed)
describe the problem replacement, etc)
 Roofs/Gutters /
 Ceilings /
 Walls /
 Blackboards /
 Chairs/desks/tables / Need of paint and Repainting Paint labor
varnish varnishing Varnish
 Water facilities/ / Need of Additional Need of Additional plumber
Drainage System Water Sources Water Sources
 Signages /
 School garden / Grassy Needs to be cleared Grass cutter labor
Repainting of repainting
nursery
 Lighting /
 Windows /
 Doors /
 Comfort Rooms /
 School Grounds / Grassy Needs to be cleared labor
 School Canteen/Clinic /
 School Fence/ wall / Need of paint repair Cement, hallow labor
blocks
 Electricity /
 Alternative gate /
 Reference Materials /
 Laboratory equipment /
 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).

Prepared by: Noted:

MARIA LUDIVINA G. ABENOJAR August 1, 2022 ANNIE R. MOLINA

School Physical Facilities Coordinator Date of Inspection School Head