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1. ANNEX D
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RAPID SUBPROJECT SUSTAINABILITY ASSESSMENT (RSSA)
RESCUE VEHICLES
(One Vehicle One Form)
Date of Assessment (mm/dd/yy):__________________________________________________________
(1) Program: BuB-OT AM-DRROI
Funding Year: ______________________________
Project ID: ______________________________
(2) Title of Project: ________________________________________________________________________
Project Location (C/M, Province): _____________________________________________________
Project Description/s: _________________________________________________________________
______________________________________________________________________________________
Type of Rescue Vehicle (Specify): _____________________________________________________
(3) Source of Funds: (Fixed Data from SubayBAYAN – All forms Annex A – D/ no need encoding)
National Subsidy PHP (Data from Subay BAYAN
LGU Counterpart PHP (Data from Subay BAYAN
Other Source of Fund (Please Specify)___________________ PHP (Data from Subay BAYAN
Total Project Cost PHP (Data from Subay BAYAN
(4) Date Project Delivered (mm/dd/yy): _______________________________________________
(5) Is the Project booked-up as LGU asset? (Refer to LGU Accountant)
Yes (Attach proof of booking-JEV and attachment) No
(6) K the Project Insured?
Yes (Attach proof of insurance and attachment) No
(7) Is it still FUNCTIONAL/ SERVICEABLE? Yes No
(7.a) If YES:
Improvements made (If any) Estimated Cost Responsible Office
1.
2.
3.
(7.b.1) If NO, state the reasons:
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
(7.b.2) No. of Months NON-FUNCTIONAL/UNSERVICEABLE: ________________
(8) CATEGORY OF NON-FUNCTIONALITY/UNSERVICEABLE:
DISASTER DESIGN/SPECIFICATION MAINTENANCE INSTITUTIONAL
(9) Is it still OPERATIONAL? Yes No
(9.a) If YES:
Rescue Vehicle is in good working condition Vehicle is being used according to its
intended purpose
Others (specify)
_________________________________
Vehicle is being used according to its
intended purpose

2. ANNEX D
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Who maintain the rescue vehicle?
Provincial LGU City/Municipality LGU Barangay LGU
Is the rescue vehicle regularly maintained? Yes No
How much is the annual maintenance budget? PHP______________________________________
(9.b.1) If NO, state the reasons:
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
(9.b.2) No. of Months NON-OPERATIONAL/UNSERVICEABLE: ________________
Is the community aware of the project rescue vehicle? Yes No
If No, why? ______________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
Does the community consider the project as BENEFICIAL? Yes No
If Yes, in what way? ______________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
If No, why? ______________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
(10) Needed interventions to make it functional/operational/serviceable and its estimated cost.
(Prioritize the need according to urgency)
Needed Interventions
(10.a)
Estimated Cost
(10.b)
Responsible Office
(10.c)
1.
2.
3.
Photos: (Please attach)
Prepared by: Conforme:
JUAN R. RIALUBIN JOSE C. TABANDA III
Municipal Engineer Municipal Mayor
NOTED:
LEONELIN P. REYNON
MLGOO