Form 2.1 - 2.7 PCM LGOO

Form 2.
1
Department of the Interior and Local Government Financial Administration
Assessment for the Seal of Good Local Governance
CY 2019
Seal of Good Local Governance – DOCUMENTARY CHECKLIST

Form 2.1 Financial Administration
City/Municipality of : __________________________________ Income Class :

Province : __________________________________ Region :
INSTRUCTIONS: PLEASE READ BEFORE PROCEEDING TO THE ITEMS. LGOO from the Province or C/MLGOO: (1) This is the list of
documents that you must prepare for the RAT’s table assessment. (2)Tick the box before each document to indicate availability.
(3) For each available document other than the Certified Forms and photos, highlight the portion, word or phrase that supports
the data being required.
Data Available Documents

Good Financial Housekeeping
1. Audit opinion and recommendations acted ☐ LGU’s CY 2017 Annual Audit Report by the
upon Commission on Audit
☐ LGU’s CY 2018 Annual Audit Report by the
Commission on Audit
2. Compliance with the Full Disclosure Policy (CY ☐ Form 2E: Photo Documentation
2018 all quarters and CY 2019 1st quarter posting
period documents) for three (3) conspicuous
places
Financial Performance
3. Local revenue growth for the 3 consecutive ☐ Certified Form 2K (Treasurer’s Office)
Ye years (2015 to 2017) ☐ Data from SREs prepared by the Treasurer for
CYs 2015 to 2017
Financial Development
4. Local development council
4.1. Composition ☐ Executive Order/ resolution creating LDC
4.2. Meetings ☐ Minutes of the Meeting for CY 2018
4.3. Executive committee ☐ Executive Order creating LDC
4.4. Provincial Development and Physical ☐ Copy of Resolution adopting PDPFP
Framework Plan [for provinces only]
4.5. Comprehensive Development Plan [for CMs ☐ Copy of Resolution adopting CDP
only]
4.6. Local Development Investment Plan ☐ Copy of Resolution adopting LDIP
4.7. Annual Investment Program ☐ Copy of Resolution adopting AIP
4.8. Secretariat ☐ Executive Order or Resolution creating LDC
4.9. Participation of CSOs ☐ Executive Order or Resolution creating LDC
☐ List of organized and accredited CSOs
☐ Received copy of CSO’s Plan of Action
5. Utilization of 20% component of the CY 2017 ☐ Certified Form 2K (Treasurer’s Office)
Internal Revenue Allotment ☐ Data from SREs prepared by Local Treasurer
for CY 2017
6. Utilization of Performance Challenge Fund (CY ☐ Certified Form 2A (Accounting Office)
2016 and 2017), if applicable ☐ Data on PCF status of funds prepared by
Local Accountant for funds received in CYs 2016
and 2017
7. Utilization rate of funding assistance from ☐ Certified Form 2A (Accounting Office)
Assistance to Municipalities program (formerly ☐ Data on BuB-AM status of funds by Local
Bottom-Up Budgeting), if applicable [for CMs Accountant for funds received in CYs 2015 to
only] 2017
8. Approved CY 2019 annual budget ☐ Ordinance enacting the LGU’s CY 2019
annual budget
1
Department of the Interior and Local Government
CY 2019
Other Supporting Documents (to be supplied only if the listed documents are NOT yet available)
Prepared by: Certifying completeness of documentary

submission:
(Name and Signature) (Name and Signature)

LGOO from the Province, or DILG Cluster Head/LGPMS-RFP
C/MLGOO
Date signed: _____________________________ Date signed: ______________________________
2
Form 2.2
Department of the Interior and Local Government Disaster Preparedness
CY 2019

Form 2.2 Disaster Preparedness

Province : __________________________________ Region :

1. 2018 1st Place National Gawad KALASAG ☐ Form 2E: Photo Documentation
Awardee for Best LDRRMCs, or Hall of Fame
Awardee (2015 onwards)
2. Convened LDRRMC ☐ Executive Order/ similar issuance creating
LDRRMC
☐ LDRRMC Minutes of the Meeting for CY 2018
3. Functionality of LDRRMO
3a. Plantilla LDRRM Officer (Head of office) ☐ Appointment of LDRRM Officer –Head of Office
with CSC attestation
☐ CSC Resolution granting the LGU authority to
take final action on its appointment, in case the
LGU is accredited
☐ Letter for CSC Field Office transmitting copy,
and requesting attestation of appointment, in case
LGU is not accredited
3b. Plantilla LDRRMO Staff ☐ Appointment of LDRRMO staff with CSC
attestation
☐ Executive order/ similar issuance for designation
of LDRRMO staff
4. Approved PDPFP or CLUP and zoning ☐ Approved PDPFP/CLUP
ordinance ☐ Sanggunian resolution approving CLUP
☐ RLUC resolution approving PDPFP
☐ Copy of zoning ordinance
If PDPFP/CLUP is still being drafted or under review:

☐ Copy of the draft PDPFP/CLUP
☐ Certification from Regional NEDA if PDPFP is
under review
☐ Certification from PLUC or Regional HLURB if
CLUP is still under review
5. LDRRM plan and budget ☐ Approved LDRRM Plan
☐ Sanggunian resolution adopting LDRRM Plan
☐ 2019 Annual Investment Program
6. Local Climate Change Action Plan If LCCAP is separate plan:
☐ Approved LCCAP
☐ Sanggunian resolution adopting LCCAP (if
separate plan)
If LCCAP is integrated:
☐ Approved PDPFP/CLUP/CDP
☐ Sanggunian resolution adopting
PDPFP/CLUP/CDP
1
CY 2019

7. Contingency Plan ☐ Approved Contingency Plan for top 1 high risk
hazard
☐ Approved Contingency Plan for top 2 high risk
hazard
☐ Sanggunian resolution approving the Plan
8. Utilization rate of LDRRMF’s 70% allocation for ☐ Signed Report on Utilization of LDRRMF by the
disaster prevention and mitigation, Local Accountant
preparedness, response, rehabilitation and ☐ Certified Form 2A (Accounting Office)
recovery
9. CBDRRM Plans [for cities and municipalities ☐ Certified Form 2F (LDRRMO)
only] ☐ One (1) Sample CBDRRM Plan with
corresponding BDC resolution
☐ Approved 2018 Annual Investment Program
10. Early warning system ☐ Form 2E: Photo Documentation
11. Evacuation management
11a. System for registration ☐ List of evacuation centers
☐ Memorandum of Agreement if schools serve as
evacuation center
☐ System of registration stated in the Standard
Operating Procedures or similar document
☐ Sample accomplished registration document
for evacuees
☐ Copy of evacuation center info guide
11b. Equipped and trained SAR or ER teams ☐ List of organized teams and personnel
complement
☐ Inventory of equipment
☐ Accomplishment report of trainings provided to
SAR & ER Teams (with photos)
11c.Prepositioned goods and resources Memorandum of Agreement or other documents
indicating arrangement with/for:
☐ Volunteer groups;
☐ Supermarkets or groceries;
☐ Pharmacies or medical groups; and
☐ Psycho-social support.
Security services indicated in:

☐ Standards Operating Procedure
☐ PNP Security Plan
11d.Evacuation Guide ☐ Copy of evacuation guide
☐ Certified Form 2F (LDRRMO)
12. Standard Operating Procedures ☐ Standard Operating Procedures (whether a
separate document or integrated in LDRRM Plan or
Contingency Plan)
12a. LDRRM Operations Center ☐ EO or similar issuance on the activation of
LDRRM OpCen in case it is temporary or functions
24/7
☐ OpCen Employee logbook
12b. Incident Command System ☐ E.O or similar issuance establishing an incident
command system
☐ Copy of ICS Training Certificate issued by DND-
OCD
2
CY 2019

☐ LDRRMO appointment of staff with ICS
training/copy of designation of said staff to LDRRM
Office
☐ LGU ID of staff with ICS training
12c. Pre-emptive and forced evacuation ☐ E.O or similar issuance establishing pre-emptive
and forced evacuation

submission:

C/MLGOO
Date signed: Date signed:

_____________________________ ______________________________
3
Department of the Interior and Local Government Form 2.3
Assessment for the Seal of Good Local Governance Social Protection
CY 2019

Form 2.3 Social Protection

Province : __________________________________ Region :

1. CY 2018 Seal of Child-friendly Local ☐ Copy of Certificate provided by CWC for 2018
Governance [for cities and municipalities Seal of Child-friendly Local Governance (SCFLG)
only]
2. CY 2018 LSB Plan fund utilization or ☐ Certified Form 2D (DepEd)
completion rate ☐ CY 2018 Accomplishment Report of LSB Plan
☐ CY 2018 Financial Report of LSB Plan
3. Mechanisms for GAD and VAWC On GAD:
☐ EO or similar issuance institutionalizing LGU GAD
Focal Point System
☐ Ordinance approving/amending/revising LGU’s
GAD Code
☐ Resolution localizing Provincial GAD Code
☐ GAD database or information management
(printed, electronic or online) system that
generates gender statistics and sex-disaggregated
data
☐ CY 2018 GAD Accomplishment Report
☐ Certificate of Review and Endorsement of LGU’s
GPB CY 2019
☐ Certified Form 2E (DILG Field Office)
On VAWC [for cities and municipalities only]:

☐ List of barangays with VAW Desks/Monitoring
☐ Report of the Submission of Barangay Quarterly
VAWC Reports
☐ Certified Form 2E (DILG Field Office)
4. Local Code for Children ☐ Ordinance approving/amending/revising LGU’s
Code for Children
☐ Ordinance localizing Provincial Code
☐ Copy of other Code or ordinance where Local
Code for Children is integrated
5. Philhealth-accredited main health facilities ☐ Copy(ies) of 2018/2019 Philhealth-accreditation
certificates of LGU-run hospital(s) and/or facilities
☐ Certified Form 2L (Health Office) [for P/HUCs
only]
6. Compliance with Accessibility Law
6a.1. Ramps with handrails ☐ Form 2E: Photo Documentation
☐ NHIP Certification for LG buildings declared as
historical sites
☐ Copy of building plan if LG building is under
construction
1
CY 2019

6a.2. Wheelchair-accessible toilets with grab ☐ Form 2E: Photo Documentation
bar
6b. Established Persons with Disability Office ☐ Ordinance/E.O creating PDAO
(PDAO) ☐ Appointment of PDAO with CSC-attestation
☐ In case the LGU is accredited, the CSC
Resolution granting the LGU authority to take final
action on its appointment
☐ Minutes of general assembly with PWD sector
☐ Executive order constituting Personnel Selection
Board (with name of employee with disability as
member)
☐ Executive Order designating a PDAO or focal
person (for component cities and municipalities)
7. DSWD-accredited LGU-managed residential ☐ Accreditation of the facility issued by DSWD-
care facility [for provinces and HUCs only] Standards Bureau
In case facility is not LGU-managed but LGU

provides support to it:
☐ Accreditation of the facility issued by DSWD-
Standards Bureau
☐ Memorandum of Agreement between LGU
and partner-organization managing the
facility
☐ Proof of transfer of resident
8. LSWDO is a registered social worker ☐ Appointment of P/C/MSWDO with CSC-
attestation
☐ In case the LGU is accredited, the CSC
Resolution granting the LGU authority to take final
action on its appointment)
☐ PRC license of LSWDO or staff in case of
exemption
9. Indigenous Peoples Mandatory ☐ Certificate of Affirmation received by IPMR
Representation in the Sanggunian, if ☐ NCIP-RO Hold-over resolution
applicable ☐ Copy of at least one payroll for CY 2019
☐ Minutes of the Meetings for CY 2018 4th quarter
☐ Minutes of the Meetings for CY 2019 1st quarter
10. Absence of illegal dwelling units OR LGU ☐ Resolution adopting the City Shelter Plan
efforts for resettlement of informal settlers [for ☐ Status or accomplishment report on housing
cities only] projects for CY 2018 target, as indicated in the Plan
or AIP
☐ EO or similar issuance creating a task force for
the control, prevention or removal of illegal
dwelling units
☐ Certified Form 2H (PDO)
11. Implementation of Provision of Potable Water ☐ Certified Form 2A (Accounting Office)
Supply-Sagana at Ligtas na Tubig sa Lahat ☐ Data on SALINTUBIG status of funds prepared by
(SALINTUBIG) projects Local Accountant for funds received in CY 2012-
2017
2
CY 2019

submission:

C/MLGOO

_____________________________ ______________________________
3
Assessment for the Seal of Good Local Governance Peace and Order
CY 2019

Form 2.4 Peace and Order

Province : __________________________________ Region :

1. LPOC convened ☐ Certified form 2I (Local PNP)
☐ Minutes of the Meetings for CY 2018 (all quarters)
2. Anti-drug abuse council organized and ☐ EO or similar issuance creating / activating
convened P/C/MADAC
☐ Minutes of the Meetings for the CY 2018 (all
quarters)
☐ Certified Form 2I (Local PNP)
3. Implementation of Peace and Order, and ☐ LPOC Secretariat Report for CY 2018
Public Safety Plan ☐ Data on utilization of funds allocated for POPS
Plan program/ activities targeted in CY 2018
☐ Certified Form 2A (Accounting Office)
☐ CY 2018 POPS Plan Accomplishment Report
☐ Certified Form 2E(DILG Field Office)
4. Provision of logistical support to the PNP ☐ Certified Form 2I (Local PNP)
5. Organized and trained BPATs, barangay ☐ Certified Form 2I (Local PNP)
tanods, and/or any similar unit ☐ List of barangays with organized BPATs,
[for cities and municipalities only] barangay tanods, and/or other similar units
☐ List of barangays with trained BPATs, barangay
tanods, and/or other similar units
6. Drug-cleared barangay ☐ Certification of drug-cleared barangay per DDB
Res. No. 3 S.2017
7. Firecracker and pyrotechnic devices ☐ Ordinance or similar issuance stating total ban of
regulation [for cities and municipalities only] firecrackers and pyrotechnic devices OR
designating specific zones for manufacturing,
display and exhibition of firecrackers
1
CY 2019

submission:

C/MLGOO

_____________________________ ______________________________
2
Assessment for the Seal of Good Local Governance Business-friendliness and
CY 2019 Competitiveness

Form 2.5 Business-friendliness and Competitiveness

Province : __________________________________ Region :

1a. Finalist of the PCCI's Most Business-Friendly LGUs ☐ Copy of Recognition received from PCCI
Award
1b. Ranked among the Top 50 in the 2018 Cities ☐ Copy of Recognition received from NCC
and Municipalities Competitiveness Index
[for cities and municipalities only]
2. Presence of local economic and investment ☐ Executive order or similar issuance creating
promotion office the LEIPO or designating an officer for LEIP with
listed functions, duties and responsibilities
3. Presence of citizen’s charter for securing ☐ Form 2E: Photo Documentation
permits for new business and business renewal ☐ Ordinance or similar issuance adopting
[for cities and municipalities only] citizen’s charter
4. Simplified business processing and licensing ☐ Sample transactions for renewal and new
system [for cities and municipalities only] businesses for 2019
☐ Certified Form 2B (BPLO)
Business One Stop-Shop [for cities and ☐ Memorandum of Agreement or any
municipalities only] document that proves the establishment of BOSS
(seasonal or all-year round)
5. Tracking system for business / investment- ☐ Database or electronically-generated report
related data [for cities and municipalities only] where business application forms are tracked
and summarized
6. Local Investment Incentive Code [for cities ☐ Copy of Ordinance approving/amending the
only] LIIC
7. Completion or utilization of Conditional ☐ Status of financial accomplishment of CMGP
Matching Grant to Provinces for Road Repair, projects for CY 2016 and 2017
Rehabilitation and Improvement (formerly ☐ Certified Form 2A (Accounting Office)
KALSADA program) [for provinces only]
1
CY 2019

submission:

C/MLGOO

_____________________________ ______________________________
2
Assessment for the Seal of Good Local Governance Environmental Management
CY 2019

Form 2.6 Environmental Management

Province : __________________________________ Region :

1. Convened local solid waste management ☐ Copy of Executive Order or similar issuance
board creating the LSWMB
☐ Minutes of the meeting in CY 2018
2. No operating open and/or controlled ☐ Certified Form 2M (Local ENRO)
dumpsite [for cities and municipalities only] ☐ Approved Safe Closure and Rehabilitation Plan
☐ Certification from DENR-EMB regional office
stating that LGU’s dumpsite is already closed
☐ Dumpsite closure inspection report by DENR-
EMB Regional Office
☐ Received copy of LGUs letter to EMB requesting
for technical assistance in crafting SCRP
3. Approved 10-Year Solid Waste Management ☐ Issuance from NSWMC approving the LGU’s SWM
Plan Plan
☐ Approved SWM Plan
☐ In the case Plan is still under review of NSWMC:
Copy of letter duly received by the NSWMC
requesting the agency to review SWM Plan of LGU
4. Materials Recovery Facility [for cities and ☐ Form 2E: Photo Documentation
municipalities only] ☐ If facility is in partnership with a private entity:
Memorandum of Agreement
5. Access to sanitary landfill [for cities and ☐ Certified Form 2M (Local ENRO)
municipalities only] ☐ Form 2E: Photo Documentation
☐ Memorandum of Agreement if sanitary landfill is
in partnership with a private entity
☐ Project progress report of on-going construction
of sanitary landfill
☐ Proof that alternative technology is recognized
by DENR-NSWMC as alternative to sanitary landfill
1
CY 2019

submission:

C/MLGOO

_____________________________ ______________________________
2
Assessment for the Seal of Good Local Governance Tourism, Culture and the
CY 2019 Arts

Form 2.7 Tourism, Culture and the Arts

Province : __________________________________ Region :

1. Tourism Development ☐ Certified Form 2H (PDO)
1.1. Presence of a local tourism office or officer ☐ EO or similar issuance creating a local tourism
office or designating an officer for tourism
development and promotion with listed
functions, duties and responsibilities
☐ Appointment of local tourism officer with CSC
attestation
1.2. Tourist information and assistance center or ☐ Form 2E: Photo Documentation
desks ☐ Ordinance or similar issuance creating the
tourist information and assistance center or desk
1.3. Tracking system of tourism data ☐ Database or record book where tourism data
are tracked and summarized (scanned copy)
☐ Form 2E: Photo Documentation
2. Cultural Heritage Promotion and Conservation
2.1. Presence of a local council for culture and ☐ Copy of Sanggunian Resolution or similar
the arts issuance creating a local council for culture and
the arts
2.2. Utilization of the budget appropriated for ☐ Certified form 2A (Local Accountant)
the conservation and preservation of ☐ Copy of 2018 Annual budget
cultural property, CY 2018 ☐ Copy of 2018 Annual Investment Program
2.3. Presence of a Cultural property ☐ Inventory of cultural property
inventory/registry in the LGU ☐ Letter of acknowledgement from NCCA
2.4. Documented and published narrative of ☐ Copy of published narrative
history and culture ☐ Form 2E: Photo Documentation
☐ Proof of LGU acknowledging narrative
published by a third party
1
CY 2019

submission:

C/MLGOO

_____________________________ ______________________________

Form 2.1 - 2.7 PCM LGOO

Hochgeladen von

Dokumentinformationen

Originaltitel

Copyright

Verfügbare Formate

Dieses Dokument teilen

Dokument teilen oder einbetten

Freigabeoptionen

Stufen Sie dieses Dokument als nützlich ein?

Sind diese Inhalte unangemessen?

Copyright:

Verfügbare Formate

Form 2.1 - 2.7 PCM LGOO

Hochgeladen von

Copyright:

Verfügbare Formate

Form 2.

Seal of Good Local Governance – DOCUMENTARY CHECKLIST

City/Municipality of : __________________________________ Income Class :

Data Available Documents

Data Available Documents

Prepared by: Certifying completeness of documentary

(Name and Signature) (Name and Signature)

Date signed: _____________________________ Date signed: ______________________________

Seal of Good Local Governance – DOCUMENTARY CHECKLIST

City/Municipality of : __________________________________ Income Class :

Data Available Documents

If PDPFP/CLUP is still being drafted or under review:

Data Available Documents

Security services indicated in:

Data Available Documents

Prepared by: Certifying completeness of documentary

(Name and Signature) (Name and Signature)

Date signed: Date signed:

Seal of Good Local Governance – DOCUMENTARY CHECKLIST

City/Municipality of : __________________________________ Income Class :

Data Available Documents

On VAWC [for cities and municipalities only]:

Data Available Documents

In case facility is not LGU-managed but LGU

Prepared by: Certifying completeness of documentary

(Name and Signature) (Name and Signature)

Date signed: Date signed:

Seal of Good Local Governance – DOCUMENTARY CHECKLIST

City/Municipality of : __________________________________ Income Class :

Data Available Documents

Prepared by: Certifying completeness of documentary

(Name and Signature) (Name and Signature)

Date signed: Date signed:

Seal of Good Local Governance – DOCUMENTARY CHECKLIST

City/Municipality of : __________________________________ Income Class :

Data Available Documents

Prepared by: Certifying completeness of documentary

(Name and Signature) (Name and Signature)

Date signed: Date signed:

Seal of Good Local Governance – DOCUMENTARY CHECKLIST

City/Municipality of : __________________________________ Income Class :

Data Available Documents

Prepared by: Certifying completeness of documentary

(Name and Signature) (Name and Signature)

Date signed: Date signed:

Seal of Good Local Governance – DOCUMENTARY CHECKLIST

City/Municipality of : __________________________________ Income Class :

Data Available Documents

Prepared by: Certifying completeness of documentary

(Name and Signature) (Name and Signature)

Date signed: Date signed:

Das könnte Ihnen auch gefallen

Date signed: _ Date signed: __