SGLGB Form 4 (Checklist)
Identifying Information
Region : _______________________________
Barangay : _______________________________
City/Municipality: _______________________________
Province : _______________________________
Seal of Good Local Governance for Barangay
Data to be Certified by the City / Municipal Local Government Officer
Remarks (pls. indicate if no
Indicator Data Requirements
data)
1. Level of Compliance with the BFDP Compliance:
Barangay Full Disclosure Policy CY 2018 4Q ________
(BFDP)
Presence of the BFDP Board
2. Functionality of the Barangay BPOC Monitoring Form 2:
Peace and Order Committee Functionality of the BPOC ___________
(BPOC) pursuant to DILG MC
2008-101
3. Functionality of the Barangay AO/EO/Ordinance or similar issuance organizing
Anti-Drug Abuse Council the BADAC:
(BADAC) pursuant to DILG- Yes _____ No______
DDB JMC No. 2018-101
IEC on illegal drug demand reduction:
Yes _____ No______
Date of last meeting: ______________
Committee on Operations:
Yes _____ No______
Committee on Advocacy:
Yes _____ No______
Certified by:
_____________________________
Signature over printed name
C/MLGOO
Date: _____________________
SGLGB Form 4.1
Identifying Information
Region : _______________________________
Barangay : _______________________________
City/Municipality: _______________________________
Province : _______________________________
Seal of Good Local Governance for Barangay
Data to be Certified by the City/Municipal Budget Officer
(In coordination with the City/Municipal Accountant and Bookkeeper)
Remarks (pls. indicate if no
Indicator Data Requirements
data)
1. Approval of the Annual Budget Budget approved and submitted to the
City/Municipal Budget Office before December
31, 2017:
Yes _____ No______
Re-enacted Budget used for FY 2018
Yes _____ No______
2. Use of Barangay Cashbook Barangay Cashbook:
(latest report) Yes _____ No______
Updated: Yes _____ No______
With Bookkeeper: Yes _____ No_____
According to COA standards:
Yes _____ No______
3. Submission of the Disbursement DV submitted:
Voucher a. On the 10th day of every month
Yes _____ No______
b. Every month but was late once or twice
Yes _____ No______
c. Monthly but was late 3-12 times
Yes _____ No______
d. 1-11 times only
Yes _____ No______
4. Percentage increase in the local Total amount collected from fees and charges, tax
resources collection, etc in:
CY 2017: PhP__________
CY 2018: PhP__________
5. Posting of the citizen’s charter in Citizen’s Charter with provisions on:
the barangay a. Barangay certification
Yes _____ No______
b. Barangay clearance
Yes _____ No______
c. Community tax certificate
Yes _____ No______
d. Barangay records, data and similar
documents
Yes _____ No______
e. Barangay facilities and properties
Yes _____ No______
f. Katarungang Pambarangay
Yes _____ No______
Citizen’s Charter with Vision and Mission
Statement:
Yes _____ No______
Citizen’s Charter with feedback mechanism:
Yes _____ No______
6. Establishment of a feedback Drop box: Yes _____ No______
mechanism
Test messaging or e-mails or hotlines
Yes _____ No______
Public Assistance and Complaints Desk Officer:
Yes _____ No______
7. Enactment of a Barangay Tax Barangay Tax Ordinance:
Ordinance Yes _____ No______
Updated:
Yes _____ No______
Certified by:
________________________________
Signature over printed name
Budget Officer
Date: _____________________
SGLGB Form 4.2
Identifying Information
Region : _______________________________
Barangay : _______________________________
City/Municipality : _______________________________
Province : _______________________________
Seal of Good Local Governance for Barangay
Data to be Certified by the Disaster Risk Reduction and Management Officer
Remarks (pls. indicate if
Indicator Data Requirements
no data)
1. Functionality of the Barangay Executive Order or similar creating the
Disaster Risk Reduction and BDRRMC
Management Committee Yes _____ No______
(BDRRMC) Approved BDRRM Plan
Yes _____ No______
Date of last meeting: ____________
2. Accomplishment rate of the Total number of activities/projects in the CY
activities/projects reflected in 2018 BDRRM Plan: _________
the Barangay Disaster Risk
Reduction and Management Total number of accomplished
Plan or the Community- activities/projects in the CY 2018 BDRRM
Based DRRM Plan Plan: _________
N = (Total number of activities/projects
accomplished / Total number of
activities/projects reflected in the BDRRM
plan) x 100
Accomplishment Rate: __________ %
3. Number of drills conducted Earthquake: _____
(earthquake, fire and others) Fire:_____
Others: _______
4. Establishment of an Early EWS: Yes _____ No______
Warning System (EWS) Link to higher LGUs:
Yes _____ No______
Community is aware of the EWS:
Yes _____ No______
5. Number of available First aid kit: Yes __ No__
functional disaster equipment Flashlight with batteries: Yes __ No__
Two-way radio / mobile phone:
Yes __ No__
Rescue vehicle / barangay patrol:
Yes __ No__
Generator set: Yes __ No__
Certified by:
__________________________________
Signature over printed name
LDRRMO
Date: _____________________
SGLGB Form 4.3
Identifying Information
Region : _______________________________
Barangay : _______________________________
City/Municipality: _______________________________
Province : _______________________________
Seal of Good Local Governance for Barangay
Data to be Certified by the Barangay
Remarks(pls. indicate if no
Indicator Data Requirements data)
1. Compliance with the Barangay Location of the BFDP Board:
Full Disclosure Policy (BFDP) ____________________
2. Financial Accomplishments Any of the following:
reported during the conduct of the Post-activity report re conduct of the CY 2018
Barangay Assembly Day (BAD) BAD indicated therein the report on financial
accomplishment; or
Financial Accomplishment Report; or
State of Barangay Address indicated therein the
report on financial accomplishment:
a. 1st Semester BAD:
Yes ______
No ______
b. 2nd Semester BAD:
Yes ______
No ______
3. Display of disaster-related Signages: Yes _____ No______
signages, markers and directional With instructions going to the evacuation center:
signs in strategic locations Yes ____ No____
Location of the said signages:
_____________________
4. Establishment of an Evacuation Evacuation Center:
Center a. Owned:
Yes _____ No______
b. Designated:
Yes _____ No______
Location of the Evacuation Center:
_____________________
5. Organization of the Barangay Executive Order or similar creating the Barangay
Emergency Search and Response Search and rescue Teams: Yes _____ No______
Teams or similar entities Date Issued: ______________
Total number of Teams: _______
Trainings conducted in the past 12 months: Yes
_____ No______
Title of Trainings:
1.
2.
6. Establishment of a Day Care Day Care Center: Yes _____ No_____
Center
Barangay Day Care Worker:
Yes _____ No______
Location of the Day Care Center:
___________________
7. Designation of priority lanes for Signages pertaining to priority lanes:
the disadvantaged sectors Yes _____ No______
8. Registration of Kasambahay With Kasambahay Desk
Yes _____ No______
List of registered Kasambahays:
Yes _____ No______
9. Percentage of cases settled under Total number of cases filed: ______
the Katarungang Pambarangay
Total number of cases settled: ______
Percentage of cases filed: _______%
10. Maintenance of a Record of RBI: Yes _____ No______
Barangay Inhabitants (RBI) or
similar
Prepared by:
__________________________________
Signature over printed name
Barangay Secretary
Certified by:
__________________________________
Signature over printed name
Punong Barangay
Date: _____________________
SGLGB Form 4.4
Identifying Information
Region : _______________________________
Barangay : _______________________________
City/Municipality : _______________________________
Province : _______________________________
Seal of Good Local Governance for Barangay
Data to be Certified by the Local Social Welfare Development Officer (LSWDO)
Remarks (pls. indicate if
Indicator Data Requirements no data)
1. Functionality of the Violence Ordinance or similar creating the VAW
Against Women (VAW) Desk: Yes _____ No______
Desk
VAW Desk Person trained:
Yes _____ No______
Submitted VAWC reports:
a. 1Q Yes _____ No______
b. 2Q Yes _____ No______
c. 3Q Yes _____ No______
d. 4Q Yes _____ No______
Number of late submission of reports: _______
2. Participation rate of day care Total number of children age 2-3 years old:
attendance _______
Total number of children age 2-3 years old
attending day care: _______
Certified by:
__________________________________
Signature over printed name
C/MSWDO
Date: _____________________
SGLGB Form 4.5
Identifying Information
Region : _______________________________
Barangay : _______________________________
City/Municipality : _______________________________
Province : _______________________________
Seal of Good Local Governance for Barangay
Data to be Certified by the City / Municipal Health Officer
Remarks(pls. indicate if no
Indicator Data Requirements data)
1. Accessibility to Health Care Executive Order or similar
Services in the Barangay appointing/designating the:
a. Barangay Health Worker (BHW):
Yes _____ No______
b. Barangay Nutrition Scholar (BNS):
Yes _____ No______
Location of the Barangay Health Station /
Center: ___________________
Certified by:
________________________________
Signature over printed name
C/MHO
Date: _____________________
SGLGB Form 4.6
Identifying Information
Region : _______________________________
Barangay : _______________________________
City/Municipality: _______________________________
Province : _______________________________
Seal of Good Local Governance for Barangay
Data to be Certified by the City / Municipal Planning and Development Officer
Remarks (pls. indicate if no
Indicator Data Requirements data)
1. Functionality of the Barangay Executive Order or similar creating the BDC: Yes
Development Council (BDC) _____ No______
Approved Barangay Development Plan (BDP):
Yes ____ No_____
Minutes of meeting: Yes ____ No_____
¼ CSO membershop:
Yes ____ No_____
2. Representation of CSOs in the Executive Order or similar creating the BBIs with
Barangay Based Institutions CSO representation:
(BBIs) a. BDRRMC: Yes ____ No_____
b. BDC: Yes ____ No_____
c. BPOC: Yes ____ No_____
d. BADAC: Yes ____ No_____
e. BESWMC: Yes ____ No_____
f. BCPC: Yes ____ No_____
g. Barangay GAD Focal Point System: Yes
____ No_____
3. Implementation of Programs, Approved BDP/AIP with PPAs for:
Projects and Activities (PPAs) a. Women Yes ____ No_____
for the disadvantaged sectors b. Children Yes ____ No_____
c. Senior Citizen Yes ____ No_____
d. PWDs Yes ____ No_____
4. Implementation of Programs, Anti-illegal drug prevention PPAs in the
Projects, and Activities (PPAs) Barangay Development Plan / AIP:
on anti-illegal drugs Yes _____ No______
Certified by:
__________________________________
Signature over printed name
C/MPDO
Date: _____________________
SGLGB Form 4.7
Identifying Information
Region : _______________________________
Barangay : _______________________________
City/Municipality : _______________________________
Province : _______________________________
Seal of Good Local Governance for Barangay
Data to be Certified by the Chief of Police
Remarks(pls. indicate if no
Indicator Data Requirements data)
1. Presence of Barangay Tanods Regular patrol/ronda:
Yes _____ No______
Attended capacity building activities / skills
enhancement training/seminar:
Yes _____ No______
Certified by:
__________________________________
Signature over printed name
Chief of Police
Date: _____________________
SGLGB Form 4.8
Identifying Information
Region : _______________________________
Barangay : _______________________________
City/Municipality : _______________________________
Province : _______________________________
Seal of Good Local Governance for Barangay
Data to be Certified by the City / Municipal Environment and Natural Resources Officer
Remarks (pls. indicate
Indicator Data Requirements if no data)
1. Functionality of the Materials MRF type:
Recovery Facility (MRF) a. Barangay-owned:
Yes _____ No______
b. Clustered: Yes _____ No______
Other materials recovery scheme:
a. Solid waste transfer station or sorting station
Yes _____ No______
b. Drop-off center:
Yes _____ No______
c. Composting facility:
Yes _____ No______
d. Recycling facility:
Yes _____ No______
2. Effectiveness of the No Ordinance or similar on No Littering Rule: Yes
Littering Rule and other _____ No______
Ordinance
Signages/markers on No Littering Rule: Yes
_____ No______
Absence of litter and/or garbage dumps in the
barangay:
Yes _____ No______
3. Presence of a Collection Ordinance or similar issuance on segregation of
System to Ensure Segregation wastes-at-source:
of Wastes-at- Source Yes _____ No______
4. Organization of the Barangay Executive Order or similar issuance organizing
Ecological Solid Waste the BESWMC:
Management Committee Yes _____ No______
(BESWMC)
Approved Solid Waste Management
Program/Plan:
Yes _____ No______
Certified by:
_________________________________
Signature over printed name
C/MENRO
Date: _____________________
