2021 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY SGLGB Form No.

1
Assessment Period: CY 2019
Data Capture Form

Identifying Information

Region : _______________________________
Barangay : _______________________________
City/Municipality : _______________________________
Province : _______________________________

CORE AREA 1: SAFETY, PEACE AND ORDER

INDICATORS DATA DATA HOW TO ASSIGN PASSIN SCORE DOCUMENT

REQUIREMENTS SOURCE DETERMINE THE ED G OBTAIN SUBMITTED
SCORE SCORE SCORE ED BY
THE
BARANG
AY
1. Functionality of the Functionality of Barangay If the result is: 8 4 No need to
Barangay Anti-Drug BADAC based on Secretary ● High = 8 put score and
Abuse Council DILG-DDB JMC No. ● Moderate = 4 attach MOV
(BADAC) 2018-01 DILG ● Low = 2
City/Municipal ● No data = 0 Scores and
Office MOV will be
coming from
the City
Assessment
Team

2. Functionality of the BPOC Monitoring DILG If the result is: 5 4 No need to

Barangay Peace and Form No. 2 based City/Municipal ● High = 5 put score and
Page 1 of 21
 2021 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY SGLGB Form No. 1
Assessment Period: CY 2019
Data Capture Form

Order Committee on DILG MC No. Office ● Moderate = 4 attach MOV

(BPOC) 2020-047 ● Low = 3
● Non functional = Scores and
1 MOV will be
● No BPOC= 0 coming from
● No data = 0 the City
Assessment
Team
3. Performance Rate in LTIA Form 003 DILG If the result is: 4 2 No need to
the Lupong based on DILG MC City/Municipal ● 85-100 = 4 put score and
Tagapamayapa No. 2016-58 Office ● 80-84 = 3 attach MOV
Incentives Awards ● 75-79 = 2
(LTIA) ● Below 75 = 1 Scores and
● No data = 0 MOV will be
coming from
the City
Assessment
Team
4. Maintenance of RBI form A of DILG Barangay ● With RBI = 1 1 1
Record of Barangay MC No. 2008-144 Secretary ● Without RBI = 0
Inhabitants (RBI) Date of last update:
_______

5. Professionalizing EO or similar Barangay With EO or similar 1 1

the Barangay Tanod issuance on the Secretary issuance:
based on DILG MC organization of the Yes = 1
No. 2003-42 Barangay Tanod No = 0

Training attended With trainings 1 1

for CY 2019 attended:
Yes = 1

Page 2 of 21
 2021 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY SGLGB Form No. 1
Assessment Period: CY 2019
Data Capture Form

No = 0
TOTAL 20 13

CORE AREA 2: FINANCIAL ADMINISTRATION AND SUSTAINABILITY

Page 3 of 21
 2021 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY SGLGB Form No. 1
Assessment Period: CY 2019
Data Capture Form

INDICATORS DATA REQUIREMENTS DATA HOW TO PERFECT PASSING SCORE DOCUMENT

SOURCE DETERMINE SCORE SCORE OBTAINED SUBMITTED
THE SCORE BY THE
BARANGA
Y
1. Compliance BFDP Monitoring Form 1 , DILG Presence of 2 2
with the Form 2 and Form 3 City/Municipal BFDP Board
Barangay Full pursuant to DILG MC No. Office ● Yes = 2
Disclosure 2014-81 ● No = 0
Policy (BFDP) Onsite Compliance to 3 3
CY 2019, 4th Qtr
compliance: Inspection the design
_____________________ pursuant to
_ Annex 7 of the
DILG MC No.
Location of the BFDP 2014-81:
Board: ● Yes = 3
_____________________ ● No = 0
_ If the result of CY 8 6
2019, 4th Qtr
compliance is:
● Full
Compliance =
8
● Partial
Compliance:
o 7 financial
documents
posted = 7
o 5-6 financial

Page 4 of 21
 2021 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY SGLGB Form No. 1
Assessment Period: CY 2019
Data Capture Form

documents
posted = 6
o 3-4 financial
documents
posted = 4
o 1-2 financial
documents
posted = 2
● Non-
compliance =
0
● No data = 0
2. Percentage Barangay Budget Barangay With increase? 3 3
Increase in Preparation Form No. 2: Treasurer ● Yes = 3
local Actual Income and ● No = 0
resources Expenditure

Total amount collected City/Municipal

from fees and charges: Accountant

CY 2018 PhP ________

CY 2019 PhP ________

Difference : PhP
_________
Percentage increase:
_____
3. Conduct of Monitor report on the Barangay Conducted 4 4
Barangay compliance of the Secretary Barangay
Assembly for barangays to conduct Assembly:
Page 5 of 21
 2021 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY SGLGB Form No. 1
Assessment Period: CY 2019
Data Capture Form

the first and barangay assembly to be 1st Semester = 2

second submitted thru shared 2nd Semester = 2
semester of google drive No data = 0
CY 2019
TOTAL 20 18

CORE AREA 3: DISASTER PREPAREDNESS

INDICATORS DATA DATA HOW TO ASSIGN PASSIN SCORE DOCUMENT

Page 6 of 21
 2021 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY SGLGB Form No. 1
Assessment Period: CY 2019
Data Capture Form

REQUIREMENTS SOURCE DETERMINE THE ED G OBTAINE SUBMITTED

SCORE SCORE SCORE D BY THE
BARANG
AY
1. Functionality of the 5% BDRRM Fund in Barangay With at least 5% 2 2
Barangay Disaster the Barangay : PhP Secretary/ BDRRM Fund
Risk Reduction and __________ Barangay allocation
Management Treasurer ● Yes = 2
Committee To compute % ● No = 0
(BDRRMC) allocation for Local Disaster
LDRRMF: Risk Reduction
and
(BDRRMF Allocated Management
/ Estimated Total Officer
Revenue from (LDRRMO)
Regular Sources) x
100

EO or similar Organization of the 1 1

issuance creating BDRRMC
the BDRRMC ● Yes = 1
● No = 0
● No data = 0
Approved Barangay With Approved 2 2
Disaster Risk BDRRM Plan
Reduction and ● Yes, using the
Management prescribed
(BDRRM) Plan template = 2
under NDRRMC ● No = 0
Memorandum

Page 7 of 21
 2021 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY SGLGB Form No. 1
Assessment Period: CY 2019
Data Capture Form

Circular No. 01,

Series of 2018

Minutes of the Conduct of quarterly 2

quarterly meeting meeting 1
● 4 out of 4 = 2
● 2 or 3 out of 4 =
1
● 1 out of 4 = 0
● No = 0
● No data = 0
Utilization Rate of Utilization of the 1
the 70% component 70% BDRRM Fund 1
of the BDRRM Fund ● 50% and above
=1
To compute for % ● Less than 50% =
utilization: 0.5
● No = 0
% utilization of the ● No data = 0
70% BDRRMF =
(Total Amount
Utilized / Total
Amount Allocated) x
100
● Accomplishment Barangay Accomplishment 3 2
Report Secretary Rate of the
Activities/Projects
Local Disaster Reflected in the
How to compute? Risk Reduction Barangay Disaster
Accomplishment and Risk Reduction And

Page 8 of 21
 2021 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY SGLGB Form No. 1
Assessment Period: CY 2019
Data Capture Form

A Management Management Plan

rate = x 100
B Officer (BDRRMP)
(LDRRMO) ● 60% and above
o A = Total number =3
of ● 40 – 59% = 2
activities/projects ● 20 – 39% = 1
accomplished in ● 19% and Below
the BDRRM plan =0
● No BDRRM Plan
=0
o B= Total number
of
activities/projects
in the BDRRM
Plan
2. Extent of risk Date of drill/s Barangay With Post-Activity 1 1
assessment and conducted: Secretary Report:
Early Warning ________________ ● Yes = 1
System (EWS) Local Disaster ● No = 0
Drills conducted Risk Reduction Conducted drills 1 1
(Earthquake, fire, and ● Earthquake/Fire/
etc.) Management Others = 1
Officer ● No = 0
(LDRRMO)
Local risk map Presence of Local 1 1
risk map
● Yes = 1
● No = 0
Early Warning Presence of Early 1 1
System (EWS) Warning System
Page 9 of 21
 2021 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY SGLGB Form No. 1
Assessment Period: CY 2019
Data Capture Form

location: ● Yes = 1
________________ ● No = 0

3. Extent of EO or similar Barangay With EO or similar 1 1

preparedness for issuance creating Secretary issuance creating
effective response Barangay the Barangay
and recovery Emergency Search Local Disaster Emergency Search
and Rescue Team/s Risk Reduction and Rescue Team/s
and ● Yes = 1
Total number of Management ● No = 0
Emergency Search Officer
and Rescue (LDRRMO) Provision of training 1 1
Team/s: _________ to the Emergency
Search and Rescue
Team/s:
● Trained in the
past 12 months
(CY 2019) = 1
No training in the
past 12 months (CY
2019) = 0
Designated/Evacuat Presence of 1 1
ion Center location : Evacuation
________________ Center/Designated
____________ Evacuation Center
● Yes = 1
● No = 0
Disaster equipment: Disaster equipment 2 1
● 2-way radio / ● 2-way radio /
mobile phone mobile phone =
Page 10 of 21
 2021 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY SGLGB Form No. 1
Assessment Period: CY 2019
Data Capture Form

● Rescue 0.5
vehicle/Baranga ● Rescue
y patrol vehicle/Baranga
● Generator set y patrol = 0.5
● First aid kit ● Generator set =
● Flashlight with 0.5
batteries ● First aid kit /
Flashlight with
batteries = 0.5
TOTAL 20 17

ESSENTIAL AREA 1: SOCIAL PROTECTION AND SENSITIVITY

INDICATORS DATA REQUIREMENTS DATA HOW TO ASSIGNED PASSING SCORE DOCUMENT

SOURCE DETERMINE SCORE SCORE OBTAINED SUBMITTED
THE SCORE BY THE
BARANGA
Y
Page 11 of 21
 2021 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY SGLGB Form No. 1
Assessment Period: CY 2019
Data Capture Form

1. Functionality of Functionality of the Barangay If the result is: 1 1 No need to

the Violence Violence Against Secretary ● Ideal = 1 put score
Against Women Women (VAW) Desk ● Mature = 0.5 and attach
(VAW) Desk based on MC No. 2017- Local Social ● Basic - MOV
114 dated 30 August Welfare and Progressive =
2017 Development 0.25 Scores and
Officer ● No MOV will be
coming
Functionality
from the
=0 City
Assessment
Team
VAWC Cases Quarterly Submission of 2 1
Reports Quarterly
● 1st Qtr submitted: Reports on
__________ VAWC Cases
● 2nd Qtr submitted: ● 1st Qtr report
_________ submission =
● 3rd Qtr submitted: 0.5
__________ ● 2nd Qtr report
● 4th Qtr submitted: submission =
__________ 0.5
● 3rd Qtr report
submission =
0.5
● 4th Qtr report
submission =
0.5
Certificate of VAW Desk 1 1
Attendance/Participation Person is trained
Page 12 of 21
 2021 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY SGLGB Form No. 1
Assessment Period: CY 2019
Data Capture Form

and Date of ● Yes = 1

Training/Seminar ● No = 0
____________

2. Access to EO or similar issuance Barangay Presence of EO 1 1

health and on the Appointment of Secretary or similar
social welfare Barangay Health Worker issuance on the
services in the (BHW) On site appointment of
barangay inspection BHW
● Yes = 1
● No = 0
EO or similar issuance Presence of EO 1 1
on the appointment of or similar
Barangay Nutrition issuance on the
Scholar (BNS) appointment of
BNS
● Yes = 1
● No = 0
Barangay Health Presence of a 1 1
Station/Center (BHS/C) BHS/C
Location: ● Maintained
___________________ BHS/C = 1
_ ● With access
BHS/C (check the to other
corresponding answer) BHS/C = 0.5
____ Barangay ● None = 0
owned/maintained
____ With access to Availability of 2 1
other BHS/C services in the
BHS/C
Page 13 of 21
 2021 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY SGLGB Form No. 1
Assessment Period: CY 2019
Data Capture Form

● Expanded
Program on
Immunization
(EPI) = 0.5
● Maternal
Care = 0.5
● Nutrition Care
= 0.5
● Other
Services =
0.5
● None = 0
3. Functionality of DILG-MC No. 2019-69 Punong If the result is: 1 1
the Barangay DILG MC No. 2019-112 Barangay ● High - Ideal =
Development ● Annex 3 (C/MAT 1
Council (BDC) Audit Form) Barangay ● Moderate =
● Annex 4 (C/M Secretary 0.5
Consolidated Results ● Low = 0.25
Form) ● Non-
Functional =
0.15
● None = 0
● No data = 0
4. Representation EO or similar issuance Barangay With EO or 1 1
of CSOs in the organizing each of the Secretary similar issuance
Barangay following: organizing the
Based 1. BDC BBIs (with CSO
Institutions 2. BADAC representative
that is accredited
Page 14 of 21
 2021 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY SGLGB Form No. 1
Assessment Period: CY 2019
Data Capture Form

(BBIs) 3. BDRRMC by the

a. BDC 4. BPOC Sangguniang
b. BADAC 5. BESWMC Barangay):
c. BDRRMC 6. BCPC ● 4 to 7 BBIs =
d. BPOC 7. Barangay GAD 1
e. BESWMC Focal Point System ● 1-3 out of 7
f. BCPC BBIs = 0.5
g. Barangay ● No EO or
CSO Assembly/Election similar
GAD Focal Report
Point issuance = 0
System
5. Registration of DILG MC No. 2013-061 Barangay With established 2 2
Kasambahay ● KR Form 5 – Secretary kasambahay
and Barangay desk:
Establishment Consolidated Public Yes = 1
of Kasambahay Kasambahay Report Employment No = 0
Desk Service
Office Maintained and
updated
kasambahay
masterlist KR
Form 5:
Yes = 1
No = 0
6. Functionality of DILG MC No. 2008-126 Barangay If the result is: 1 1 No need to
the Barangay ● LCPC Form 1-A Secretary ● Ideal = 1 put score
Council for the ● Mature = 0.5 and attach
Protection of ● Basic - MOV
Children (BCPC) Progressive =
0.25 Scores and
Page 15 of 21
 2021 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY SGLGB Form No. 1
Assessment Period: CY 2019
Data Capture Form

● No MOV will be
Functionality coming
=0 from the
City
Assessment
Team
7. Allocation for the PCW, DILG, DBM and Barangay With approved 1 1
Annual Gender NEDA JMC No. 2016-01 Secretary Barangay GAD
and ● Annex D-1 Plan and Budget:
Development Yes = 1
(GAD) Plan and No = 0
Budget
TOTAL 15 13

ESSENTIAL AREA 2: BUSINESS-FRIENDLINESS AND COMPETITIVENESS

INDICATORS DATA DATA HOW TO ASSIGNED PASSING SCORE DOCUMENT

REQUIREMENTS SOURCE DETERMINE THE SCORE SCORE OBTAINED SUBMITTED
SCORE BY THE
BARANGAY
1. Enactment of Barangay Tax Barangay Presence of 3 3
Ordinance Secretary Barangay
Page 16 of 21
 2021 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY SGLGB Form No. 1
Assessment Period: CY 2019
Data Capture Form

Barangay Tax Barangay Revenue Ordinance:

Ordinance Code Barangay ● Presence of
Treasurer Barangay Tax
Ordinance = 3
● No Barangay
Tax Ordinance
=0
2. Enactment of an Barangay Ordinance Barangay Presence of 3 3
ordinance Secretary Barangay
relative to Ordinance:
Barangay Barangay ● Presence of
Clearance fees Treasurer Barangay
on business Ordinance = 3
permit and ● No Barangay
locational Tax Ordinance
clearance for =0
building permit
3. Approval of a Barangay Barangay Presence of 2 2
resolution Resolution Secretary Barangay
authorizing the Resolution:
City/Municipal Barangay ● Presence of
Treasurer to Treasurer Barangay
collect fees for Resolution = 2
Barangay ● No approved
Clearance for Barangay
Business permit Resolution = 0
and locational
clearance

Page 17 of 21
 2021 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY SGLGB Form No. 1
Assessment Period: CY 2019
Data Capture Form

purposes
4. Issuance of Record book Barangay Timeliness of 7 5
Barangay Treasurer issuance of
Clearance1 within barangay
seven (7) working clearance
days (for ● 90%-100% of
businesses applications
which do not met = 7
require ● 80%-89% of
occupancy applications
permits). For met = 5
locational ● 70%-79% of
clearance, applications
issuance of met = 3
Barangay ● 60%-69% of
Clearance in not applications
more than three met = 2
(3) working days ● 50%-59% of
from application applications
at the met = 1
city/municipality ● 49% and below
of applications
met = 0
TOTAL 15 13

1
Item 5.1 of DILG MC No. 2019-177 dated October 17, 2019 – Barangay Clearance refers to any and all documents issued by the barangays with or without
corresponding fees as defined in their ordinances relative to or in relation to the issuance of business permit and locational clearance by the city/municipality
or any other permit as may be required.
Page 18 of 21
 2021 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY SGLGB Form No. 1
Assessment Period: CY 2019
Data Capture Form

ESSENTIAL AREA 3: ENVIRONMENTAL MANAGEMENT

INDICATORS DATA DATA HOW TO ASSIGNED PASSING SCORE DOCUMENT

REQUIREMENTS SOURCE DETERMINE THE SCORE SCORE OBTAINED SUBMITTED
SCORE BY THE
BARANGAY
1. Presence of a ● MRF (check the Onsite Presence of MRF: 2 1
Materials corresponding inspection ● Yes = 2
Recovery answer) ● None but with
Facility (MRF) ____ Barangay other materials
pursuant to owned recovery
R.A. 9003 ____ Clustered scheme = 1

Page 19 of 21
 2021 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY SGLGB Form No. 1
Assessment Period: CY 2019
Data Capture Form

Brgys ● None = 0

● Location of MRF
● MOA
2. Presence of a Ordinance on Barangay Presence of 2 2
Collection segregation-at- Secretary Ordinance on
System to source segregation of
Ensure wastes-at-source
Segregation of ● Yes = 2
Wastes at ● No = 0
Source
3. Functionality of EO or similar Barangay If the result is: 2 2
Barangay issuance on the Secretary EO organizing the
Ecological Solid organization of the BESWMC
Waste BESWMC ● Yes = 1
Management ● No = 0
Committee Approved Solid Approved 1 1
(BESWMC) Waste Management BESWMC
Program/Plan Program/Plan
(Any template or ● Yes = 1
annotated) ● No = 0
Allocation of With fund 1 1
barangay funds, allocation:
approved by the ● Yes =1
sangguniang ● No = 0
barangay
Conduct of capacity- Capacity-building 2 2
building for activity conducted:
Page 20 of 21
 2021 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY SGLGB Form No. 1
Assessment Period: CY 2019
Data Capture Form

BESWMC Yes = 2
No = 0
TOTAL 10 9

I certify to the correctness of the above information.

____________________________________
Punong Barangay

Page 21 of 21