Republic of the Philippines

Department of Education
REGION IV-A CALABARZON
Schools Division of Rizal
___________________________________________________________________________________________________________________________________________
BRIGADA ESKWELA
(Name of School)
(School Address)
School Year _ _ _ _
BE FORM 1

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 Manpower
(Check One) improvement Needed Material Resources
Needed(Indicate
FACILITIES (e.g. repair, Needed (Indicate kind
quantity and nature of
If Unsatisfactory, repainting, and quality)
labor services needed)
Satisfactory Unsatisfactory describe the replacement, etc)
problem
 Roofs/Gutters

 Ceilings

 Walls

 Blackboards

 Chairs/desks/tables

 Water facilities/
Drainage System

 Signages

___________________________________________________________________________________________________________________________________________

Address: DepEd Bldg., Cabrera Road, Brgy. Dolores, Taytay, Rizal 1920
Telephone No: OSDS 8571-4284/ 8650-2615 / 8650-2639 / 8650-2612 / 8695-3877
SGOD 7061720 / CID 650-2610
Email Address: rizal@deped.gov.ph Website: depedrizal.ph

“Sulong Blue Rizal”

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 School garden

 Lighting

 Windows

 Doors

 Comfort Rooms

 School Grounds

 School Canteen/Clinic

 School Fence/ wall

 Electricity

 Alternative gate

 Reference Materials

 Laboratory equipment

Prepared by: Noted:

_______________________________ _________________ ____________________________________

School Physical Facilities Coordinator Date of Inspection School Head

___________________________________________________________________________________________________________________________________________

Address: DepEd Bldg., Cabrera Road, Brgy. Dolores, Taytay, Rizal 1920
Telephone No: OSDS 8571-4284/ 8650-2615 / 8650-2639 / 8650-2612 / 8695-3877
SGOD 7061720 / CID 650-2610
Email Address: rizal@deped.gov.ph Website: depedrizal.ph

“Sulong Blue Rizal”

 Page 3 of 3

NOTE: Schools can utilize the hazard map made by the Student-led Watching Team and generate other improvement plans from School Governing Council.

___________________________________________________________________________________________________________________________________________

Address: DepEd Bldg., Cabrera Road, Brgy. Dolores, Taytay, Rizal 1920
Telephone No: OSDS 8571-4284/ 8650-2615 / 8650-2639 / 8650-2612 / 8695-3877
SGOD 7061720 / CID 650-2610
Email Address: rizal@deped.gov.ph Website: depedrizal.ph

“Sulong Blue Rizal”