Header / LGU Letter head ANNEX B. PERSONS WITH DISABILITY AFFAIRS OFFICE ANNUAL ACCOMPLISHMENT REPORT ‘Year under Review: Date of Submission: Sex (Disaggregated Total No.) |Z ‘Age Range 1 88 with this Type of Disability Female Male ] fi | $5 sé Ze a3 = | “Tobie may be expanded or use another sheet gathered data 5 PDAO/FP Functionality é : |OURC! ICES ] estagusimn ( RESOUEEES, | POLICES, PLANS. 8 BUDGET | connucr or mecrncs | paRruenspiNTaTEs (Indicate Ordinance ee e {list dates of meetings | (List conducted activities w/ packa omen furnishings, tools, etc. from IRA; programs tap efenereiah ew : or brecutive Orc") | compliant to BP 344) | for daily operations) integrated in AIP?) Metpoip/eends) ae ee “Table may be expanded or use onather sheet to fit Prepared by: othered data. Submitted by: [signature above Printed Name] [Position] [Signature above Printed Name] [Position] Approved by: ignature above Printed Name of LCE] [Position, LGU]ANNEX C PERSONS WITH DISABILITY AFFAIRS OFFICE / FOCAL PERSON Functionality Assessment Form Year under Review Date of Submission Region Province City/Mun, INDICATOR RATING REMARKS Establishment 20% | Choose one: at. For Provinces, Cities, and 1*' to 3" income class Municipalities, the PDAO is established through Ordinance (20%) -or- ‘a2. For 4" to 6" income class Municipalities, the PWD FP is appointed by Executive Order (20%) Accessibility 15% Choose one: a1. Physical location of PDAQ is easily accessible to Persons with Disabilities (5%) ~ oF- 2, Physical location of PWD FP office/desk is easily accessible to Persons with Disabilities (5%) b. PDAOIFP has installed accessibility facilties/ devices such as: © Ramps (1%) co Support rails (1%) © Reserved parking space for Persons with Disabilities (1%) Wheelchair-friendly doors (1%) Wheelchair-friendly restrooms (1%) Braille (1%) Sign language interpreters (1%) Assistive signages (1%) Tactile tiles (1%) © Others (1%) _ ooo0000 Resources 10% a. Furniture and Vehicle o Tables and chairs (1%) ©. Filing cabinet storage area (1%) © Sofa bed, folding bed, or mat (1%) © Availability of vehicle and/or transportation expenses to convey Persons with Disabilities (1%) . Equipment and Supplies ‘© Landline or mobile phone (1%) © Computer, especially for PWD database purposes (1%) o_ Camera (0.5%)© Voice recorder (0.5%) o_ First aid kit and other medicines (1%) ©. Monitoring Tools © Logbooks ‘© Logbook for violations of RAs 7277, 9442, 10754 (0.5%) © Logbook recording violence against Persons with Disabilities (0.5%) © Forms © Feedback Form (0.5%) o_ Referral Form (0.5%) Policies, Plans, and Budget | 15% a. PDAO/FP budget allocated in IRA (7.5%) b. PDAO/FP PPAs integrated in AIP (7.5%) Conduct of Meetings _ 5% ‘a. Regular conduct of public consultations by the PDAOIFP with Persons with Disabilities in the ‘community on the formulation and implementation of local policies for their well-being (2.5%) b. Regular conduct of townhall meetings by the PDAOIFP with Persons with Disabilities in the community to get their views and concerns on local and national issues affecting them (2.5%) Partnership Initiatives 10% ‘a. PDAOIFP actively encourages and coordinates with CSOs and the private sector in the conduct of programs, initiatives, and activities that would engage the participation of and provide benefit to Persons with Disabilities (10%) Accomplishments 25% a. PDAO/FP has submitted the Annual Accomplishment Report (choose one): © intime (25%) 1 to 2 working days late (20%) 3.10 4 working days late (15%) 5 to 6 working days late (10%) 7 working days late and beyond (5%) loo oo OVERALL RATING LEVEL OF FUNCTIONALITY _| indicate level below: Basic 20% and below Progressive 21% to 50% Mature 51% to 80% Ideal 81% to 100% Assessed by: [Name] [Position]Level of Functionality of Persons with Disa Region ANNEX D As of: Province =: s==n ss sen City/Municipality deal Mature Progressive Basic Remarks “Table may Be expanded or use another sheet, Feeded. Prepared by: Submitted by: Approved by: [Name] [Name of DILG Provincial Director] [Position/Designation/Rank] [Position/Designation/Rank] Prepared on: Submitted on: Approved on:Level of Functionality of Persons with Disability Affairs Office per Province Province As of: ANNEX E City/Municipality ‘Ideal Mature Progressive Basic Remarks “Table may be expanded or use another sheet, if needed. a Prepared by: Submitted by: Approved by [Name] [Name] [Name of DILG Regional [Position/Designation/Rank] [Position/Designation/Rank] [Position/Designation/Rank] Prepared on’ Submitted on: Approved on: