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

Total Members at BDRRMC _______

# marginalized representa
# of community group

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

Prepared by:

Gewna Christine O. Gonesto

Signature over Printed Name

______________________

Position

Approved by:

Ildebrando O. Romares

Signature over Printed Name

_______________________

Position

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

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