FORM 5 Barangay Checklist

Proposed Community Service Program

For ( _______________)
Place where service shall be accomplished (______________)

No, of Hours/ Barangay Programs/Projects

Days

Pollution control and protection of environment

(Street Sweeping, Garbage Disposal, Unclogging of
canals, Tree Planting)
Traffic and/or crowd control in Brgy Road
Peace and Order Program (night watch and crime
prevention campaign)
Maintenance and/or Repair of Barangay Properties
(Cleaning of Brgy. Hall, Barangay patrol, barangay
covered court etc)
Information Dissemination of various national, local
and barangay programs such as (giving away
leaflets, and in announcement)
Projects Involving Delivery of Basic Services such as
1 ________________________
2. _______________________
3, _______________________

Other Projects or Programs requiring Physical

Activities
1._______________________
2. _______________________
3. _______________________

Prepared by: Approved by:

ESTEBAN GARFIN DENNIS L. ESOLA
Brgy. Secretary Punong Barangay