2023 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY

Year Under Review: CY 2022

HUC/ICC Consolidated Performance Assessment Form

HUC/ICC:
REGION:

Assessment Result per Governance Area

Put a (✔️) if PASSED, (❌) if FAILED

CORE GOVERNANCE ESSENTIAL GOVER

No. Barangay
Financial
Safety, Social
Administration Disaster
Peace and Protection and
and Preparedness
Order Sensitivity
Sustainability

1 Ex. Barangay A ✔️ ✔️ ✔️ ✔️
2 Ex. Barangay B ❌ ✔️ ✔️ ✔️
3
4
5
6
7
8
9
10
11
12
13
14
15
TOTAL

Summary of SGLGB Assessment

A. Total Number of Barangays in the HUC/ICC:
B. Total Number of Barangays assessed by the HUC/ICC PAT:
C. Percentage of Barangays assessed (Formula: B/A x 100)
D. Total Number
E. Percentage of of SGLGB
SGLGB Passers
Passers in in
thethe HUC/ICC:
HUC/ICC:
(Formula: D/B x 100)
We hereby certify that the information herein are true and correct, and are accordingly supported
by the undersigned.

Highly Urbanized City/Independent Component City Performance Ass

Team Leader:

Name and Signature of the Team Leader

Position/Designation of the Team Leader

Assistant Team Leader:

Name and Signature of the Assistant Team Leader

Position/Designation of the Assistant Team Leader

Members:

Note: Based on the EO re Creation of the HUC/ICC PAT, please list down all the members

Name and Signature of the Member

Date Accomplished:
 ANCE FOR BARANGAY
CY 2022 SGLGB FORM No. 5
e Assessment Form

er Governance Area SGLGB Result

ED, (❌) if FAILED
Note:
ESSENTIAL GOVERNANCE If a barangay
passed 3 Core
Areas AND at least
Business-
Environmental 1 Essential Area,
Friendliness and put “PASSED”;
Management
Competitiveness otherwise, put
“FAILED”
❌ ✔️ PASSED
✔️ ✔️ FAILED

essment
25
20
80.00%
15
75.00%
are accordingly supported by required documents as reviewed
gned.

nent City Performance Assessment Team:

eader:

of the Team Leader

of the Team Leader

am Leader:

e Assistant Team Leader

e Assistant Team Leader

bers:

list down all the members using the following format:

Position/Designation of the Member