Assessment On SBM Practices Checklist Form

Annex A Division Memorandum No. ___, s.
2012
DepED, Division of Cebu City

ASSESSMENT OF SBM PRACTICES LEVEL 1
DIMENSION I SCHOOL LEADERSHIP
SBM PRACTICES/INDICATORS
Means of Verification
Technical Assistance
Needed from DO
SBM 1.1 The school head: Has an appointment
Attested appointment (CSC)
Basic SBM Training
Certificate of participation/attendance
on SBM training
SIP/AIP Training
Certificate of
participation/attendance on SIP
training
Annual School Budget (ASB)

Training
of (ASB) training
Fiscal Management training
on Fiscal management
Appointment papers/designation
Plantilla (DBM)
signed by SDS
Designation by the SDS
Is aware of his/her basic roles and responsibilities in school improvement
Certificate of attendance/
Documents showing attendance in
participation in induction and/or
induction and/or orientation on basic
orientation on basic leadership and

leadership and management roles of
management roles training of the
the school head
school head
School Annual Improvement Plan
Approved SIP/AIP
document
SBM 1.2 The school head: Has attended SBM related trainings
Certificate of participation
/attendance on ICT
SBM 1.3 The school head: Initiates organization of stakeholders
Copy of
Documents showing roles and
handbook/manual/guidelines/by responsibilities of each organized
laws/MOA on the roles and
internal/external stakeholder group
responsibilities of internal /external
stakeholders
List of officers of Internal Stakeholders:
ICT related training
Student organization
Parent organization
Teacher organization
List/s of officers and members of

student organization/s
List of general PTA officers
List of faculty club /Teacher
Association officers
List of officials of External Stakeholder group:
LGU
Lists of barangay officials
Local organizations
List/s of officers and members of

local organization/s initiated by the
school head
Records of meetings/orientation on
roles & responsibilities of each
internal / external stakeholder group
Documentation Report
SBM 1.4 The school head: Initiates the installation of the required SBM mechanisms/systems
Cebu City SBM Assessment of Level I Practices Practices and MOVs
Page 1
Organized teams and list of membership per team:
Management Information
System (MIS)
School Memo/Designation of the

different (MIS) working committees
SIP-School Planning Team
List of SIP School planning team
INSET Mechanism
School Memo/Designation of INSET

Team
M&E Mechanism
School Memo/Designation of M & E

Team
Financial Management System
School Memo/Designation of
Financial Management System Team
School Staffing System
School Memo/Designation of School

Staffing System Team
Records of orientation on SBM

systems and organizational set up of
school teams
SBM 1.5 The school head: Performs fund management duties

Records of resource generation from the different sources:
MOOE
Records/Documents of MOOE
downloaded and Liquidation
reports
LSB /SEF
Request letters address to LSB/SEF

for fund assistance
Adopt-a-School
Adopt A School Documents (MOA,

Certificate of Acceptance, etc.)
Donations
Records of Deed of Donations for

donated resources /List of donated
resources submitted to Division
Office / Documentation Report
Income generating projects
Documentation Report / Project

Description
PTCA support
Others, (Pls. specify) ________
DIMENSION II INTERNAL STAKEHOLDERS

Page 2
Needed from DO
SBM 2.1 PUPILS/STUDENTS; TEACHERS; PARENTS: Are aware of their rights and responsibilities as
primary stakeholders
Report on the conduct of orientation regarding their rights, roles and responsibilities as stakeholders:
Pupils/Students
Documents/Narrative report on the

conduct of pupils orientation on
their rights, roles and responsibilities
Teachers

conduct of teachers orientation on
their rights, roles and responsibilities
Parents

conduct of
parents orientation on their rights,
roles and
responsibilities
Copies of the following:
Pupils/Students Handbook
Copies of Pupils/Students Handbook
Magna Carta of Teachers/DepEd

Service Manual
Copies of Magna Carta of

Teachers/DepEd Service
Manual/Education Act of 2001 (RA
9155)
Provisions on Parents roles and

- Education Act of 1982
responsibilities found in DepEd
- DepEd Order No. 54, s. 2009

Service Manual/Education Act of
- PD 603
1982
Existence of School Organizations(name of organization and list of officers)
- List of Pupils/Students School
Pupils/Students
Organizations and
- List of Members and Officers
- List of Officers and Teachers
Teachers
Organizations
List of Parents Organizations and
Officers:
- General PTA Officers,
Parents
Grade/Year Level, Homeroom
PTA Officers
- Other organizations (e.g.
Parents Brigade)
Constitution and by-laws:
Pupils/Students
SSG/SPG By-laws
Teachers
Teachers Organization By-laws
Parents
PTA By-laws/DepEd Order No. 54, s.

2009
Minutes of the meetings on school improvement:
Pupils/Students
Teachers
Parents Association
Minutes of SSG/SPG Meetings

Minutes of Teachers Organization
Meetings
Minutes of Parents Organization
Meetings
SBM 2.2 Teachers are trained on curriculum content and pedagogy
Page 3
Report on training needs analysis
Accomplished and Consolidated

TSNA
List of Teachers with corresponding

trainings attended on curriculum
content and pedagogy
SBM 2.3 Teachers apply knowledge, process skills and instructional innovations acquired from participation
in trainings
Report on trainings attended
Lesson plan showing the application

of methodologies learned
Sample of Lesson Plans showing

application of skills, innovations and
methodologies learned from trainings
Reports on utilization of IM,

reference books,
workbooks, lesson exemplars,

etc./Documentation reports such as
logbook, borrowers card, etc.
Records of teacher observation
Observation Tracking/Progress
results showing improvement in
Reports/Clinical Observation Reports
teaching/learning process
(e.g. Form 178, TLOC, etc.)
Student Performance Progress
Report/Consolidated Students
Records of evaluation results
Performance per grading
showing increased student
period/subject area (e.g. Form XIV,
performance
ORV Results, PHIL-IRI, Math Basic
Computation Reports, etc.)
SBM 2.4 Parents: Assume responsibilities as partners in the learning process
Records/journals of parents
Records/Pictures of Parents
visit/participation in interventions e.g.
Participation in school
reading program, feeding program
activities/services
and others
Records of parent-volunteers as
Records/Pictures of parents
teacher aides, para teachers, tutors,
participation/support in instruction
remedial teachers, etc
Documents on utilization of
Instructional materials, reference
books, workbooks, lesson
exemplars, etc.
DIMENSION III EXTERNAL STAKEHOLDERS
Needed from DO
SBM 3.1 External stakeholders: have a clear and common understanding of their rights, responsibilities and
functions in school improvement
Records of attendance to SBM orientations by the following stakeholders :
Local School Board (LSB) / LGU
Record of Attendance
Alumni/Youth Group
Retirees/Elders
Professionals/Barangay Health
Workers/Traditional Birth Assistants
Religious Groups/Church leaders or

ministers
Non-government Organizations /
Cooperatives/Church Organizations
School Governing Council
Others, (Pls. specify) ___________
SBM 3.2 External stakeholders: School Community are organized to support/implement SBM
Page 4
Existence of organizations (name of organization and list of officers)

Name of the Organization with List
Alumni
of Officers
Retirees
of Officers
Professionals
of Officers
Religious Groups
of Officers
Non-government Organizations
of Officers

of Officers

of Officers
Minutes of the meeting/s on school improvement:
Minutes of the meeting on school
improvement
Retirees
improvement
Professionals
improvement
Religious Groups
improvement
Non-government Organizations
improvement

improvement

improvement
SBM 3.3 External stakeholders: Are mobilized to support SBM and the implementation of the SIP
Reports/records of
Document Report /Minutes/records
meetings/orientation of external
of meetings/orientation on SIP/AIP
stakeholders on SIP/AIP and its
and its implementation
implementation
Alumni
Work plans of external stakeholders

aligned to the SIP/AIP
Work plan
Reports/records of
Document Report/Minutes of
meetings/orientation on other
meetings and orientation on
possible school community

possible school community
partnerships
partnership
SBM 3.4 External stakeholders: Local Government stakeholders are fully aware of their roles and
responsibilities
Report/records of
Document Report/minutes of
meetings/orientation/training/briefing
meetings/orientation/training/briefing
of Local Government stakeholders

of Local Government stakeholders
on their duly recognized roles and
on their roles and responsibilities
responsibilities related to SBM
related to SBM
Report on/records of participation of
local government unit in the

Document report
development of the SIP/AIP
DIMENSION IV SCHOOL IMPROVEMENT PROCESS

Page 5
Needed from DO
SBM 4.1 School conducts assessment of SBM practices using assessment tool
Accomplished self-assessment
guide on SBM practices
Accomplished self-assessment
guide on SBM practice
Analysis of SBM assessment

results
List of strength and weaknesses

based on SBM assessment results
Data on school performance

indicators gathered
BEIS/SRC (for the last 3 years).
Analysis of school data against

National Standard
Comparative data on school

performance indicators against
National Standard
Records on the trend analysis of

results on the assessment of SBM
Level 1 Assessment Result

Practices submitted to the Division
for provision of technical assistance
SBM 4.2 School Governing Council is organized
List of officers with roles and
List of officers with roles and
responsibilities
responsibilities
Constitution and by-laws

Copy of Constitution and By-laws
Code of Conduct
Copy of Code of Conduct
Operating procedures
Copy on Operating Procedures
List of committees with roles and
List of committees with roles and
responsibilities
responsibilities
SBM 4.3 The school has: Knowledge-based and participatory SIP/AIP formulation
Documents/Records showing
Communication from the SPT
School Planning Team (SPT)
inviting stakeholders to participate in

leading the development of the
the development of SIP/AIP
SIP/AIP
The SIP has the following basic contents:
School and community profile
School and community profile
Situational analysis that is data

driven (based on School MIS)
Situational analysis that is data

driven (based on School MIS)
School vision, mission, goals and

objectives
Priority Improvement Areas
School vision, mission, goals and

objectives
Priority Improvement Areas
Work and Financial Plan
Work and Financial Plan
Records of involvement of
stakeholders in SIP formulation
stakeholders in SIP formulation,
attendance sheets, pictorials
Document on implementation
structure
The AIP has the following contents:
Priority Improvement Areas for the
current year
Objectives
Implementation structure documents
Approved AIP copies

Approved AIP copies
Programs, projects or activities
Approved AIP copies
Resource requirement
Approved AIP copies
Timeframe
Approved AIP copies
Amount and sources of funds
Approved AIP copies
SBM 4.4 Stakeholders are informed, consulted and engaged in SIP/AIP formulation and implementation
Page 6
stakeholders representatives in the
SIP/AIP formulation
Invitation/communication sent to
stakeholders
Copy of the SIP planning team

bearing the signatures of the
stakeholders, `-minutes during the

meeting
SBM 4.5 Performance-based Incentives and Rewards System for pupils/students and teachers installed in
school and supported by the SGC
Guidelines on Incentives and Rewards System for
stakeholders representations in the
SIP/AIP implementation
Pupils/students
Guidelines set by SPG, Teachers

and approved by SGC
Teachers
Guidelines set by SPG, Teachers

and approved by SGC
Results of pilot implementation on

the guidelines on Incentives and
Rewards System
Copy of results
Copy of revised guidelines on

incentives and rewards system
implemented
SBM 4.6 The school emphasizes improvement of school outcomes
Comparative results before the
SIP/AIP implementation attained
implementation and after the
the goals and objectives relevant to

implementation of the AIP relevant to
school performance indicators
school performance indicators.
Revised guidelines on incentives

and rewards system implemented
DIMENSION V SCHOOL-BASED RESOURCES

Needed from DO
SBM 5.1 The school: Has an Annual School Budget (ASB) aligned with the Annual Improvement Plan (AIP)
ASB submitted and reviewed by the

Division Office
Annual School Budget (ASB)
ASB reflecting Maintenance and

Other Operating Expenses (MOOE)
and other sources of funding for AIP
programs/projects
ASB aligned with Approved AIP
Procurement plan aligned with ASB
Approved APP supports the ASB,
ASB submitted to DepEd Division

representative (SDS or District
Supervisor) to the LSB
ASB submitted to SDS (school copy

must be stamped received)
Records of
representation/advocacy for LSB
support to SIP/AIP made by DepEd
representative
Letter requests/documents re:

assistance from LSB
SBM 5.2 The Annual School Budget (ASB) resulted in the attainment of school targets and desired learning
outcomes
Page 7
ASB supported interventions/ programs/projects attained school targets on:

SRC/Summary Report of Enrolment
Enrollment
for the last 3 years, (supported by
SIP Goal Chart and BEIS
Drop Out Rate
SRC/Summary Report of Drop Out

Rate for the last 3 years, (supported
by SIP Goal Chart and BEIS
Retention Rate
SRC/Summary Report of Retention

Completion Rate
SRC/Summary Report of Completion

SRC/Summary Report of
Achievement Rate for the last 3
Achievement Level
years, (supported by SIP Goal Chart
and BEIS
SBM 5.3 The school manages and controls funds with minimal fiscal authority/autonomy
Records on utilization of
Liquidation Reports of Cash
downloaded school MOOE with

Advances (MOOE Download)
assistance from Division Office
Copy of recent Bond of Government
Division Memo granting School
Officials/Memo issued by SDS
Head minimal signing authority on

authorizing grant of Cash Advances
financial transactions
for MOOE/DepEd Memo re: Schools
with Fiscal Autonomy (OUs/IUs)
Designation of fiscal staff signed by
School Memo designating fiscal
the Principal for schools without

staff
fiscal autonomy
Designated fiscal staff trained on
Certificate of Training on
bookkeeping and disbursement

bookkeeping and disbursement
processes
processes
SBM 5.4 The allocation Optimally utilized and disbursement of funds is aligned to SIP/AIP/ASB and
recorded, reported and accounted for
Records of needs analysis (SIP
Priority Improvement Areas (aligned
identified programs and projects)

with SIP/AIP/ASB)
undertaken
Records of simple accounting
Liquidation Report Audited by
(O.R.,RER, expenses receipts,
Division Internal Audit Unit for
other supporting documents to

MOOE and Liquidation Report of
vouch transactions) of MOOE and
other sources of funds
other sources of funds submitted
Annual Procurement Plan prepared
Approved APP
and submitted
DIMENSION VI SCHOOL PERFORMANCE ACCOUNTABILITY
Page 8
Needed from DO
Page 9
SBM 6.1 The school:

Has mechanisms for transparency and accountability
Has installed and operationalized Monitoring and Evaluation System
Documents showing monitoring and evaluation tools on:
M & E Tool for SIP /AIP
Implementation of SIP/AIP
Implementation
Consolidated Form 14 per Grading
period, PHIL-IRI, ORV, Monthly
Tracking of student performance

DORP Report, SREA, NAT, Basic
Computation in Grade 3 Math, CFSS
STS.
Tracking of teacher performance
RPAST/CBPAST, Clinical
Observation Tool, Form 178
SGC operations
M & E Tool on SGC Operations
Fund management
M & E Tool on Fund Management
Guidelines on:
Monitoring and Evaluation
Transparency and Accountability
M&E reporting system
Committees organized involving

internal and external stakeholders
in M&E
Guidelines on M & E
Guidelines on Transparency and
Accountability
Guidelines on M & E Reporting
system
Guidelines on the organization of
committees organized involving
internal and external stakeholders in
M&E
Reports on briefing/orientation on
transparency and accountability
Attendance and Minutes
conducted
SBM 6.2 The school: Informs and involves major stakeholder in the monitoring and evaluation
Records of reports and information provided to the:
Superintendent
Received copy of M & E reports

submitted to SDS
LSB

submitted to LSB
PTCA

submitted to PTA
SGC

submitted to SGC
Others, (Pls. specify)

_____________

submitted to other stakeholders
(optional)
Records of involvement of the:
Division Officials
LSB
PTCA
SGC
Others, (Pls. specify) __________
Documentation Report (optional)
SBM 6.3 The school: Monitors and evaluates improvements in student performance indicators per class,
per student, per subject
Page 10
Documents of targets on school

performance indicators (enrolment,
retention rate, cohort survival rate,
completion rate and student
achievement) are disseminated to
internal and external stakeholders
Classroom level tracking of student
learning outcomes
Organized documents on tracking

of school performance indicators
Form 14 (Periodical Test, NAT Gr. 3,

6, 2nd/4th yr, NCAE), PHIL-IRI, ORV,
Monthly DORP Report, SREA, NAT,
Basic Computation in Grade 3 Math,
CFSS STS.
SRC, BEIS
DIVISION SBM PRACTICES ASSESSMENT

VALIDATION & TECHNICAL ASSISTANCE TEAMS
SBM DIMENSIONS
CHAIRMAN
TEAMS
CO-CHAIRMAN
D
1
School Leadership
Mr. Danilo
Gudelosao
Mrs. Leonicila
Lendio
D
2
Internal Stakeholders
Participation
Mrs. Grecia
Bataluna
Mrs. Delia Kiamco
D
3
External
Stakeholders
Participation
Dr. Luis Derasin
Dr. Ester Tangente
D
4
School Improvement
Process
Mr. Faviolito
Alberca
Dr. Febelyn
Bendulo
D
5
School-Based
Resources
Mr. Cipriano Balili
Mr. Liberato
Lauronilla
D
6
School Performance
Accountability
Dr. Erlinda Melgo
Mr. Wilfredo Tano
MEMBERS
Mrs. Rosalinda Tan
Mrs. Anita
Rodriguez
Mrs. Lourdes
Tolosa
Mr. Allan Pancho
Mr. Rey Lanete
Dr. Jocelyn Tejano
Mrs. Josefina Fabio
Mrs. Barlet
Maglangit
Mrs. Rhoda Labella
Mrs. Flores Delfin
Mrs. Roquesa
Sabejon
Mrs. Araceli
Gudelosao
Mrs. Jaene Aguila
Mrs. Celestina
Gohetia
Mrs. Faith Misa
Mrs. Feloiza
Catingub
Page 11

Assessment On SBM Practices Checklist Form

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Annex A Division Memorandum No. ___, s.

DepED, Division of Cebu City

SBM 1.1 The school head: Has an appointment

Attested appointment (CSC)

Basic SBM Training

Annual School Budget (ASB)

Fiscal Management training

orientation on basic leadership and

ICT related training

List/s of officers and members of

List of officials of External Stakeholder group:

Lists of barangay officials

List/s of officers and members of

Cebu City SBM Assessment of Level I Practices Practices and MOVs

Organized teams and list of membership per team:

School Memo/Designation of the

SIP-School Planning Team

List of SIP School planning team

School Memo/Designation of INSET

School Memo/Designation of M & E

Financial Management System

School Staffing System

School Memo/Designation of School

Records of orientation on SBM

SBM 1.5 The school head: Performs fund management duties

Request letters address to LSB/SEF

Adopt A School Documents (MOA,

Records of Deed of Donations for

Income generating projects

Documentation Report / Project

Others, (Pls. specify) ________

DIMENSION II INTERNAL STAKEHOLDERS

Documents/Narrative report on the

Documents/Narrative report on the

Documents/Narrative report on the

Copies of the following:

Copies of Pupils/Students Handbook

Magna Carta of Teachers/DepEd

Copies of Magna Carta of

Provisions on Parents roles and

- DepEd Order No. 54, s. 2009

Teachers Organization By-laws

PTA By-laws/DepEd Order No. 54, s.

Minutes of the meetings on school improvement:

Minutes of SSG/SPG Meetings

SBM 2.2 Teachers are trained on curriculum content and pedagogy

Cebu City SBM Assessment of Level I Practices Practices and MOVs

Report on training needs analysis

Accomplished and Consolidated

List of Teachers with corresponding

Report on trainings attended

Lesson plan showing the application

Sample of Lesson Plans showing

Reports on utilization of IM,

workbooks, lesson exemplars,

DIMENSION III EXTERNAL STAKEHOLDERS

Local School Board (LSB) / LGU

Religious Groups/Church leaders or

School Governing Council

Others, (Pls. specify) ___________

Cebu City SBM Assessment of Level I Practices Practices and MOVs

Existence of organizations (name of organization and list of officers)

School Governing Council