SGLG110PDFTOPPT.pptx

PASS ALL APPLICABLE INDICATORS
Department of the Interior and Local Government
Assessment for the Seal of Good Local Governance (Cities/Municipalities)
CY 2023
Form CM 3.1
Financial Administration and
Sustainability
Seal of Good Local Governance – REGIONAL ASSESSMENT
Form CM 3.1 Financial Administration and Sustainability
City/Municipality of : Income Class :
Province : Region :
INSTRUCTIONS: PLEASE READ BEFORE PROCEEDING TO THE ITEMS.
For the RAT Members
(1) Based on your thorough review of documents provided by the assigned DILG Field Officers and on-site visit, please supply the required information or tick applicable LGU condition under Column A. (2)
In case of a correction/erasure, the RAT leader must affix a signature parallel to the corrected portion. (3) AFFIX SIGNATURE AT THE END OF EACH ASSESSMENT AREA, and PUT INITIALS AT THE
BOTTOM OF EACH PAGE.ONLY DULY ACCOMPLISHED FORMS ARE TO BE ENCODED BY THE RFP OR PFP.
Required data LGU condition REMARKS (2023 NEW INDICATORS/SGLG DATA
SOURCE/MINIMUM REQUIREMENT)
1(N) The LGU’s audit opinion, as rendered by the
Commissionon Audit
CY 2021(please tick as appropriate) Unmodified
Qualified
Adverse
Disclaimer/No Opinion
No Annual Audit Report
Percent of fully-complied recommendations (please
supply information)
1

CY 2022(please tick as appropriate) Unmodified
Qualified
Adverse
Disclaimer/No Opinion
No Annual Audit Report
Percent of fully-complied recommendations(please
supply information)
If data in the provided NGA database contains
typographical errors, LGU submitted a portion of the
Annual Audit Report that will support the correct data (i.e.
Executive Summary and Status of implementation of prior
year's audit recommendations)(please tick as appropriate)
Yes
Not applicable
2

2(N) The LGU fully complied with posting in (please tick all
applicable items) [ ] Full Disclosure Policy Portal for CY 2022 2nd to 4th
Quarters, and CY 2023 1st Quarter posting period
documents
LIFT System reports submission is also to be
checked to verify compliance of LGUs with the
requirements of posting online. The system is a
web-based tool that will serve as a portal to
synchronize the LGU financial reporting requirements
of the oversight agencies such as the DILG, DBM,
and DOF. For CY 2023, assessments will focus on the
timely submission of the electronic Statement of
Receipts and Expenditures (eSRE) Report and the
Quarterly Report on Real Property Assessment
(QRRPA).
DATA SOURCE: List of compliant LGU on the
submission of e-SRE and QRRPA for FY 2022 from
BLGF
MOV: Proof of submission, emails, screenshot of
reports in the PORTAL
[ ] Three (3) conspicuous places for CY 2022 2nd to 4th
quarters, and CY 2023 1st Quarter posting period
documents (based on accomplished Form 2E: DILG Field
Office)
[ ] Timely submission of FY 2022-Q4 LIFT System Reports
(SRE and QRRPA)
[ ] None of the above
3(N) Average local revenue growth of LGU from CYs 2020
to 2022(please supply information)
Provinces, cities and municipalities: 7% increase in
the average local revenue growth for FYs 2020-2022
DATA SOURCE: Data on average local revenue
growth from FYs 2020 to 2022 from DOF-BLGF
3

4(N) Utilization percentage of the 20% component of the
National Tax Allotment for local development
projects(please supply information)
Provinces, cities, and municipalities:
1. Should have appropriated no less than 20%
of its IRA/NTA FY 2022 for development
projects; AND
2. Bylaws and related policies, 100%
utilization of the 20% NTA
Consideration is given to an LGU that met this
utilization benchmark as of December 31, 2022:
● Province: 65%,
● City: 66%, and
● Municipality: 77%
MOV:
● Data from SREs prepared by Local Treasurer
for the FY 2022 NTA from DBM
● Data on utilization of 20% NTA component/
Development Fund FY 2022 from DOF-BLGF
5(N) The LGU is a beneficiary of the Performance
Challenge Fund in CY 2019 and/or prior year/s Yes
No
If yes, based on the accomplished Form 2A Accountant’s
Office, the status of utilization is:(please tick as
appropriate)
The received funds are fully liquidated and disbursed
The received funds are not fully liquidated and disbursed
but all unobligated balances are reverted back to the
National Treasury
The received funds are not fully liquidatedand disbursed
4

6(N) The LGU is a beneficiaryof CY 2021 funding
assistance from Local Government Support Fund
(LGSF)(please tick as appropriate)
Yes
For beneficiary provinces, cities, and municipalities:
100% utilization of all received funds in CY 2021 as
of December 31, 2022
ADDITIONAL REQUIREMENT: All undisbursed
balances after December 31, 2022 must be reverted
back to the National Treasury
MOV:
● Data on LGSF status of funds prepared by
Local Accountant for funds received in CY
2021 (Certified Form 2A of the Accountant’s
Office)
● Data on the utilization of LGSF funds CY 2021
from SubayBayan provided by OPDS
No
If yes, based on the accomplished Form 2A Accountant’s
Office, the status of utilization is as follows:
6.1 Financial Assistance to LGUs (FA to LGUs). (please
tick as appropriate)
but all unobligated balances are reverted back to National
Treasury
Not applicable. LGU did not receive funds.
6.2 Assistance to Cities (AC). (please tick as appropriate) The received funds are fully liquidated and disbursed
Treasury
5

6.3 Conditional Matching Grant to Provinces (CMGP).
(please tick as appropriate)
The received funds are fully liquidatedand disbursed
The received funds are not fully liquidated and disbursed
Treasury
6.4 Disaster Rehabilitation and Reconstruction
Assistance Program (DRRAP).(please tick as
appropriate)
Treasury
6.5. Support to Barangay DevelopmentProgram (SBDP).
Treasury
If data in the provided NGA database contains errors,
LGU submitted certification from DILG Region’s PDMU
on the utilization rate that will support the correct data.
Yes
Not applicable
6

7 The LGU has an approved annual budget for the fiscal
year 2023.(please tick as appropriate) Yes
Provinces, cities and municipalities: CY 2023 budget
should have been approved by December 31, 2022
CY 2023 BUDGET is approved by Dec. 31, 2022 (NO
CONSIDERATION on the approval after this
period)
DATA SOURCE/MOV: Ordinance enacting CY 2023
budget
No
If yes, please indicate date of approval (dd/mm/yyyy):
[END OF FINANCIAL ADMINISTRATION AND SUSTAINABILITY]
7

Date: _______________________________
Official Release of this Form: (Please affix release stamp of DILG RO/PO here)
8

PASS ALL INDICATORS
Overall Guidance on Succeeding SGLG Assessment on Disaster Preparedness
● Starting CY 2024, GK Seal for LDRRMCOs will be the primary source of data for the SGLG’s DP area assessment. Only GK Seal Beyond Compliant and Fully
Compliant LGUs in 2023 will be qualified for SGLG 2024, subject to other results acceptability parameters to be set by the CGLG.
CY 2023
Form CM 3.2
DisasterPreparedness
Form CM 3.2 DisasterPreparedness
Province : Region :
For the RAT Members
LGU HAZARD PROFILE: Kindly provide the top 2 hazards
present in the LGU (based on PDPFP/CLUP; for use in
processingresults for CP, EWS, and EM)
Top 1 Hazard(please supply information)
1

Top 2 Hazard(please supply information)
1 The LGU has an established and functional Local
Disaster Risk Reduction and Management Council
(LDRRMC)
1.1 The LDRRMC meets standards set under R.A. No.
10121 and includes(please tick all applicable items)
[ ] At least four (4) accredited CSO members
[ ] At least one (1) private sector representative
1.2 LDRRMC convened for the following quarters of CY
2022(please tick all applicable items):
[ ] Met at least once in CY 2022 1st quarter
[ ] Met at least once in CY 2022 2nd quarter
[ ] Met at least once in CY 2022 3rd quarter
[ ] Met at least once in CY 2022 4th quarter
2 The LGU has an established Local Disaster Risk
Reduction and Management Office(LDRRMO)
2.1 The LDRRMO is headed by:
Position title(please supply information)
Salary Grade(pleasesupply information)
Nature of appointment (please tick as appropriate) Permanent
Temporary
Designated
In case appointment is temporary/designated, period
has not exceeded one year(please tick as appropriate)
Yes
No
Not applicable
2

Status of appointment(please tick as appropriate) With affixed signature of CSC Field Office (FO)
representative
Approved by LGU accredited to take final action on
appointments thru CSC Resolution
Copy is transmitted to CSC for attestation
Executive Order or similar document is issued for
designation
If copy has been transmitted for attestation, please
indicate the date received by the CSC:
If an Executive Order or similar document was issued
for designation, please indicate date of approval:
Date of appointment (please supply information)
In case plantilla position is vacant due to separation
from service, please tick all applicable items:
[ ] Vacancy happened within 2022 or 2023
[ ] Vacated position has the prescribed SG
[ ] Efforts to hire new LDRRMO is already on-going
[ ] With designated LDRRMO Head in the meantime
2.2 The LDRRMO has permanent staff.
2.2.1 Number of LDRRMO staff with plantilla
positions(please supply information)
2.2.2 Number of LDRRMO staff with temporary
position(please supply information)
2.2.3 Number of permanent staff designated from
other office(please supply information)
3

2.2.4 Number of temporary staff designated from other
office(please supply information)
2.2.5 Number of COS/Job Order/Contractual staff
designated from other office(pleasesupply information)
2.2.6 Number of vacant LDRRMO plantilla
positions(please supply information)
from service, please tick as appropriate:
[ ] Vacancy happened within 2022 to 2023
[ ] Efforts to hire new LDRRMO staff is already on-going
2.3 LDRRMO occupies a workspace(please tick as
appropriate)
Office structure / space
Designated desk space
3 The LGU has an approved Comprehensive Land Use Plan
(CLUP)(please tick as appropriate) Yes
No
3.1 If yes, the CLUP is approvedbased on(please tick as
appropriate):
[ ] (N) Department of Human Settlements and Urban
Development (DHSUD) data
[ ] Sangguniang Panlalawigan Resolution
[ ] DHSUD or HLURB Resolution
Date approved(dd/mm/yyyy)(please supply
information)
Period covered (yyyy-yyyyy)(please supply information)
LGU-NGA Data Discrepancy Check (please tick as
appropriate)
Data differ; included in the accomplished Change Request
Form
No data discrepancy
4

3.2 If no, please tick conditions applicable to the LGU's
CLUP status:
[ ] Draft was made after the lapse of the previously-approved
CLUP
[ ] Final draft is under review, at least, of PLUC / Regional
DHSUD
[ ] Final draft contains results of risk assessment per
PLUC/DHSUD Certification
[ ] No CLUP
Date final draft was received by PLUC / DHSUD
(dd/mm/yyyy)(please supply information)
Period covered by draft CLUP (yyyy-yyyy)(pleasesupply
information)
Period covered by previous CLUP (yyyy-yyyy)(please
supply information)
3.3 Engaged component barangays in the planning process
Yes
No
3.4 There is an initiative to communicate the plan to their
component barangays (please tick as appropriate)
Yes
No
4 The LGU has an approved Local Disaster Risk Reduction
and Management(LDRRM) Plan and Budget (please tick as
appropriate)
Yes
No
If yes, please tick conditions applicable to the LGU's
LDRRM Plan:
[ ] Covers CY 2023
[ ] Incorporates hazard, vulnerability and risk assessment
data
[ ] DRR-CCA development initiatives are incorporated in the
CY 2022 Annual Investment Program (AIP)
5

Date approved (dd/mm/yyyy) (please supply
information)
Period covered (yyyy-yyyy)(please supply information)
5 The LGU has a Local Climate Change Action Plan
(LCCAP)(please tick as appropriate) Yes
No
5.1 If yes, please indicate status of LCCAP [ ] Approved, stand-alone plan
[ ] Draft, stand-alone plan
[ ] Integrated in PDPFP/CLUP(climate change actions
integrated in the approved/under review PDPFP/CLUP)
[ ] Integrated in CDP (climate change actions integratedin the
approvedCDP)
information for approved LCCAP)
Period covered (yyyy-yyyy)(please supply information
for both approved and draft LCCAP)
5.2 If yes, LCCAP contain(please tick all applicable items) [ ] Results of risk assessment
[ ] Climate change adaptation and mitigation actions
5.3 Approved LCCAP (either stand-alone/integrated in
other plans) submitted to CCC
Yes
No
6

5.4 Approved CY 2023 AIP with Climate Change
Expenditure Tagging (CCET) submitted to CCC(please
Yes
No
Provinces, cities, and municipalities: Must have
the following, as verified by DRR-CCA Focal
Person of the concerned DILG-RO:
1. approved LCCAP or approved PDPFP/
CLUP/ CDP covering CY 2023 with risk
assessment and climate change
adaptation and mitigation actions
submitted to Climate Change
Commission, and
2. approved AIP for CY 2023 with CCET as
confirmed by CCC*
*Consideration for AIP, LGUs may still pass if they
submitted their AIP CY 2023 to CCC (regardless if
it has CCET or not)
For succeeding SGLG and GK assessments in CY
2024 or CY 2025, integration of GHG inventory in
LCCAP may be included in the minimum
requirement for this indicator.
The LGUs are also reminded to submit their AIP to
CCC. For CY 2024 or CY 2025, SGLG and GK
may start looking into the presence of CCET in
AIP as confirmed by the CCC. Hence, LGUs are
reminded to submit their CY 2024 AIPs ahead.
LGUs are strongly encouraged to initiate preparatory
actions for these proposed upgrades.
7

DATA SOURCE/MOV:
● Local Climate Change Action Plan
● Sanggunian Resolution adopting the LCCAP
● Approved PDPFP, CLUP, or CDP, if LCCAP is
integrated into any of these plans
● List of LGUs with LCCAP from CCC
● List of LGUs with AIP with CCET from CCC
● Proof of transmittal of LCCAP to CCC
● Proof of transmittal of AIP to CCC
Date of submission (dd/mm/yyyy)(please supply
information)
6 The LGU has Contingency Plans for its hazards(please tick
all applicable items) [ ] Top 1 hazard
Provinces, cities and municipalities: Must have an
LDRRMC-approved Contingency Plan covering CY
2023 for the ranked 1 and 2 high-risk hazards
updated for COVID/EREID concerns AND must
contain:
1. Anatomy of the Hazard;
2. Scenario Generation;
3. Affected Population;
4. Coordination, Command & Control
Protocols; and
5. Activation, Deactivation & Non-
Activation Protocols
Consideration: For updating for COVID-EREID
concerns, consideration is given to LGUs with
separate LDRRMC-approved CP covering CY 2023
devoted to these concerns.
DATA SOURCE/MOV:
● Contingency Plan for ranked 1 high-risk
[ ] Top 2 hazard
6.1 Contingency Plan for Top 1 hazard
Status of approval(please tick as appropriate) Approved
Not yet approved
information)
Plan contains the following elements(please tick all
applicable items)
[ ] Anatomy of the hazard
[ ] Scenario generation
[ ] Affected population
[ ] Coordination, command and control protocols
[ ] Activation, deactivation and non-activation protocols
[ ] Integrates COVID/EREID-related concerns and strategies
in the plan
8

6.2 Contingency Plan for Top 2 hazard
natural hazard updated for COVID/EREID and
approved by LDRRMC
● Contingency Plan for ranked 2 high-risk
natural hazards updated for COVID/EREID
approved by the LDRRMC
● LDRRMC-approved CP for COVID-EREID
concerns
Status of approval(please tick as appropriate) Approved
Not yet approved
information)
Plan contains the following elements(please tick all
applicable items)
[ ] Anatomy of the hazard
[ ] Scenario generation
[ ] Affected population
[ ] Coordination, command and control protocols
[ ] Activation, deactivation and non-activation protocols
[ ] Integrates COVID/EREID-related concerns and strategies
in the plan
Has separate LDRRMC-approved CP covering CY 2023
devoted to COVID/EREID-related concerns and
strategies(please tick as appropriate)
Yes
No
7 The LGU utilized at least 60% of the 70% Disaster
Preparedness and Mitigation component in its FY 2022
Local Disaster Risk Reduction and Management Fund
(LDRRMF)(based on certified Form 2A) (please tick as
appropriate)
Yes
No
Must have:
1. Appropriated not less than 5% of the
estimated revenue from regular sources as
LDRRMF for 2022; and
2. Utilized at least 60% of the 70% Disaster
Preparedness and Mitigation Fund of the
LDRRMF for the 2022 Current Fund as of
December 31, 2022.*
7.1 Source of Fund:
Estimated revenue from regular sources(please supply
information)
9

Amount of LDRRMF for FY 2022(pleasesupply
information) 8.3 Percent-all
* Consideration for Item 2: At least 60%
completion rate on CY 2022 PAPs as of
December 31, 2022.
LGUs shall expect an increase in the minimum
requirement for the LDRRMF utilization rate in
the succeeding SGLG and GK assessments.
DATA SOURCE/MOV:
Percent-allocation for LDRRMF(please supply
information)
7.2 Utilization of 70% component of FY 2022 LDRRMF:
Total amount of 70% component(please supply
information)
● Report on LDRRMF utilization signed by the
Local Accountant and LDRRMO
● Report of LDRRMF utilization posted in
the FDP Portal
● SRE – (Summary of Receipts and
Expenditures)
● Budget Allocation (AIP or Supplemental
Investment Program) and Utilization
Amount utilized(please supply information)
Percent-utilization of 70% component (please supply
information)
8 The LGU operates a multi-hazard Early Warning System
(EWS)
8.1 At least one (1) marker is present in high risk areas
located in the LGU for the following hazards (please tick all
applicable items)
[ ] Top 1 hazard
[ ] Top 2 hazard
8.2 With audible and wide-ranging warning and alarm
system(please tick as appropriate)
Yes
No
8.3 With automated rain gauge / locally-innovated
technology(please tick as appropriate)
Yes
No
10

8.4 Information on EWS is present in conspicuous
places(please tick as appropriate)
Yes
No
8.5 With Standard Operating Procedure (SOP) on the end-
to-end use of EWS and feedbacking mechanisms
communicated to residents in high risk areas (please tick
as appropriate)
Yes
No
9 The LGU has pre-emptive and forced evacuation
mechanism.(please tick as appropriate) Yes
No
Provinces, cities, and municipalities must have: pre-
emptive and forced evacuation mechanism captured
in an EO or equivalent issuance.
MOV:
EO or similar issuance
Photo Documentation and other similar documents
If yes, the LGU has the following: (please tick as
appropriate)
[ ] Pre-emptive and forced evacuation mechanism captured
in an EO or equivalent issuance
[ ] Tested through actual conduct of evacuation during slow-
onset disasters, as applicable
[ ] EvacuationDrill/ Exercise AAR
10 The LGU has an established Evacuation Management
system and resources in place.
10.1 Evacuationcenter
Name (please supply information)
Location(please supply information)
Status of the Evacuation Center(please tick as appropriate) Permanent
Semi-permanent
Temporary (in partnership with school / child-
development centers)
Facilitiespresent
11

a. Minimum requirements(please tick all applicable
items)
[ ] Kitchen area
[ ] Watersupply
[ ] Communicationmeans
[ ] Toilet and bath; hand-washingfacilities
[ ] Waste disposal system
b. Other functional requirements(please tick all
applicable items)
[ ] Health service station
[ ] Power supply with back-up system
[ ] Administrative office
[ ] Storagearea
[ ] Laundry Area
[ ] Provision for management of livestock and domestic
animals
c. Socially-inclusive facilities((please tick all applicable
items)
[ ] Breastfeeding station
[ ] Couples’ room
[ ] Child-friendly learning space
[ ] Ramps or other assistive devicefor PWDs and elderly
Evacuation Center Management Plan or other camp
management-related protocol/system integrating the
observation of minimum health protocols
Present
Not Available
System for registration(please tick as appropriate) Present
Not Available
Localized information guide with facilities and map in
evacuation center(please tick as appropriate)
Present
Not present
Organized EC Management Teams/Committee Present
Not Available
10.2 Percentage of barangays with evacuation information
guide (For CM only)(pls.supply information)
12

10.3 Prepositioning of goods and service
System for mobilization and management of volunteer
groups(pleasetick as appropriate)
Present
Not Available
Goods for relief operations(please tick all applicable
items)
[ ] Stockpile includes food packs and hygiene kits (indicate #
packs and kits below)
[ ] Partnership with suppliers (e.g. supermarket, pharmacy)
[ ] None
a. Number of stockpiled food packs(please supply
information)
b. Number of stockpiled hygiene kits(please supply
information)
Medical services after a disaster(please tick all applicable
items)
[ ] In-house (LGU’s own medical service)
[ ] Partnership with other government (national/local)
medical service
[ ] Partnership with private/ NGO entities
Psycho-social support(please tick all applicable items) [ ] In-house (LGU-based professionals)
offices
System to ensure peace and order and security in the event
of disasters (please tick as appropriate)
Present
Not present
Transport services for the possibly affected residents to
identified evacuation center
[ ] In-house (LGU-owned assets)
offices
13

11 The LGU has Search and Rescue (SAR) or Emergency
Response (ER) teams
11.1 Organized Yes
No
1.2 Trained on search and rescue and basic life support
relative to Top 1 and Top 2 Hazards not earlier than 2018
Yes
No
11.3 Facilitated SAR/ER training relative to Top 1 and Top
2 Hazards not earlier than 2018(please tick as appropriate)
Yes
No
11.4 Equipage(please tick all applicable items) [ ] Motorized vehicle
[ ] Generator set
[ ] Water rescue kit (at the minimum: rope, life jacket,
flotation ring or alternate)
[ ] Extrication kit (at the minimum: spine board, shovel or
alternate digging device)
[ ] Personal protectiveequipment (at the minimum: helmet,
goggles, work gloves, boots)
[ ] First aid kit
[ ] Emergency medical kit and survival kit
12 The LGU has a LDRRM Operations Center with SOP
12.1 LDRRM Operations Center(please tick as appropriate) Permanent (functions 24/7 daily)
Temporary (functions 24/7 during disasters)
None
12.2 Status of Standard Operating Procedures (SOP) for
coordination and monitoring of actions in the event of
disasters (please tick as appropriate)
Stand-alone plan/manual/protocol
Integrated in approved LDRRM Plan or Contingency Plan
Not available
13 The LGU has an Incident Command System (ICS)(please
tick as appropriate) Contained in an executive order or similar issuance
No issuance
14

13.1 Number of LDRRMC members trained in various
levels of ICS:
a. Level I(please supply information)
b. Level II(please supply information)
c. Level III(please supply information)
d. Level IV(please supply information)
13.2 Number of LDRRMO staff trained in various levels of
ICS:
a. Level I(please supply information)
b. Level II(please supply information)
c. Level III(please supply information)
d. Level IV(please supply information)
14 Percentage of barangays in the LGU that have
approved community-based disaster risk reduction and
management (CBDRRM) plans (based on accomplished
Form 2F: DRRM Office)(please supply information)
15

15 The LGU has participated in and complied with the
submission of requirements for the 2023 Gawad KALASAG
Seal for LDRRMCOs(please tick as appropriate)
Yes
Provinces, cities. and municipalities:
Must have participated and complied with the
submission of required documents to the concerned
OCD Regional Office on or before…. (not indicated yet
per technical notes)
DATA SOURCE/MOV:
● List of provinces, cities, and municipalities
which participated in the conduct of the 2023
GK Seal from OCD
● Certificate of Compliance issued by OCD
Regional Office
No
If yes, the date of the Certificate of Compliance issued by
the OCD Regional Office is (dd/mm/yyyy): (please supply
information)
[END OF DISASTER PREPAREDNESS]
Date: _______________________________
Official Release of this Form: (Please affix
release stamp of
DILG RO/PO
here)
16

PASS ALL APPLICABLE INDICATORS
CY 2023
Form CM 3.3
Social Protection and Sensitivity
Form CM 3.3 Social Protection and Sensitivity
Province : Region :
For the RAT Members
Protection and Access to Justice of Women and Children
1(N) The LGU is a 2022 Seal of Child-friendly Local
Governance recipient(please tick as appropriate) Yes
No
Not yet available
If not a recipient, please supply the following information
1.1a (N) Passing rate of LGU (please supply information)
1

1.1b (N) Ratingfor each category (please indicate
percentages)
Survival(please supply information)
Development(please supply information)
Protection(please supply information)
Participation(please supply information)
Governance(please supply information)
1.2 (N) Compliant with CFLGA indicators on: (please tick
as appropriate)
[ ] Local Code for Children
[ ] Implemented plans for children
[ ] Budget allocation and utilization
2 The LGU has mechanisms in supportof gender and
development
2.1 GAD Focal point system(please tick as appropriate) Present Not
present
2.2 GAD database(please tick as appropriate) Present Not
present
2.3 CY 2022 GAD accomplishment report(please tick as
appropriate)
Present Not
present
2.4 GAD Code
2

a. Updated City / Municipal Code(please tick as
appropriate)
Yes
No
Date adopted (dd/mm/yyyy)(please supply
information)
b. Passed ordinance(s) amending / revising existing
Code((please tick as appropriate)
Yes
No
Date passed (dd/mm/yyyy(pleasesupply information)
c. Localized Provincial GAD code(please tick as
appropriate)
Yes
No
If yes, please indicate date of adoption of Provincial
Code (dd/mm/yyyy)
2.5.a CY 2022 GAD Plan and Budget (please tick as
appropriate)
Reviewed and was found fully compliant in form and
content per PCW-DILG-DBM-NEDA JMC No. 2016-01
(based on accomplished Form CM 2E: DILG Field Office)
Submitted to DILG Field Officer for review
None of the above
2.5.b CY 2023 GAD Plan and Budget(please tick as
appropriate)
Reviewed and was found fully compliant in form and
content per PCW-DILG-DBM-NEDA JMC No. 2016-01
(based on accomplished Form CM 2E: DILG Field Office)
Submitted to DILG Field Officer for review
None of the above
2.6 CY 2022 GAD Accomplishment
3

a. Fund Utilization Rate (based on accomplished Form
CM 2A: Accountant'sOffice)
Amount allocated (please supply information)
Amount utilized(please supply information)
Percent utilization (please supply information)
b. Completion rate of PPAs (based on accomplished
Form CM 2H Planning and Development Office)(please
supply information)
3. The LGU has mechanisms in support of efforts against
trafficking and violence against women and their children
(VAWC)
Provinces, cities, and municipalities must have the
following:
1. Organized LCAT-VAWC
2. 100% of barangays with VAW Desks (C/Ms
only)
3. At least 85% of barangays with submitted
reports for all quarters of 2022*
4. Approved LCAT-VAWC Annual Work and
Financial Plan
5. Quarterly meetings of LCAT-VAWC
conducted for all quarters of CY 2022
*Consideration: At least 85% of barangays with
submitted reports in 3rd and 4th quarter of CY 2022
only
3.1 Organized Local Committee on Anti-Trafficking and
Violence Against Women and their Children (LCAT-
VAWC)(please tick as appropriate)
Yes
No
3.2 Percentage of barangays with respective VAWC desks
(based on accomplished Form CM 2J: SWD Office)(please
supply information)
3.3 Percentage of barangays with submitted quarterly
reports for CY 2022
CY 2022 - 1st quarter(please supply information)
4

CY 2022 - 2nd quarter(please supply information)
DATA SOURCE/MOV:
● Executive Order, ordinance or similar document
creating the LCAT-VAWC
● Percentage of barangays with VAW
desks/Monitoring Report of the Submission of
Barangay Quarterly VAWC Reports (Certified
Form 2J Social Welfare and Development Office)
● Copy of approved LCAT-VAWC Annual Work and
Financial Plan
● Minutes of Meeting of the LCAT-VAWC
CY 2022 - 3rd quarter(please supply information)
CY 2022 - 4th quarter(please supply information)
3.4 Approved LCAT-VAWC Annual Work and Financial Plan
Yes
No
3.5 Quarterly meetings of LCAT-VAWC conducted for all
quarters of 2022(please tick as appropriate)
Yes
No
4. The LGU has the following Efforts on Early Childhood
Care and Development (ECCD)
4.1 The LGU has encoded ECCD Child Profiles for SY 2021-
2022 in ECCD-IS (please tick as appropriate)
Yes
No
(N) Total number of enrollees in LGU-managed ECCD
facilities encoded in the ECCD-IS(please supply
information)
(N) Number of enrollees with profiles encoded in ECCD-
IS(please supply information)
Percentage of ECCD Child Profiles encoded in the
ECCD-IS(please supply information)
4.2 (N) The LGU has implemented the Supplementary
Feeding Program Cycle 11 (please tick as appropriate)
Yes
No
5

Accomplishment Rate as of March 31, 2023(please
supply information)
5. [For profiling only] Percentage of barangays with
approved Comprehensive Barangay Juvenile Intervention
Program (CBJIP)(please supply information)
Accessibility for Persons with Disabilities and Older
Persons
6 The LGU has physical features and a local office
promoting accessibility for Persons with Disabilities
(PWDs) and Older Persons
6.1 City/Municipal Hall (please tick as appropriate) [ ] Not a historical site/under construction
[ ] Historical Site
[ ] Under construction
Based on the Photo Documentation and Information in
Certified Form 2G Engineering Office. The LGU complied
with BP 344 requirements in the following:(please tick
as appropriate)
[ ] Ramps
[ ] Toilet
[ ] Signages
[ ] Parking space for persons with disabilities
If under construction, LGU has a facility or building
catering to all PWD-related concerns or services and
construction plans include the provision of ramps with
2-level handrails(please tick as appropriate)
Yes
No
6

6.2 Main hospital / health center(please tick as
appropriate)
[ ] Not a historical site/under construction
Provinces, cities and municipalities: Must have the
following in the LG building, main hospital/health
facility, and one LG-managed tertiary educational
facility/technical vocational education and training
center, if any:
Stairs (if applicable)
Walkways
Corridors
Doors and building entrance
Washrooms and toilets
Ramps
Parking space for persons with disabilities
Switches, Controls, Buzzers
Handrails
Floor Finishes
Drinking/Water fountains
Public telephone
Seating accommodations
Signages
***(Specifications indicated in the Technical Notes)
[ ] Historical Site
with BP 344 requirements in the following: (please tick
as appropriate)
[ ] Stairs (if applicable)
[ ] Walkways
[ ] Corridors
[ ] Doors and building entrance
[ ] Washrooms and toilets
[ ] Ramps
[ ] Switches, Controls, Buzzers
[ ] Handrails
[ ] Floor Finishes
[ ] Drinking/Water fountains
[ ] Public telephone
[ ] Seating accommodations
[ ] Signages
[ ] Elevator (if applicable)
7

Yes
No
6.3 Tertiary Education Facility / TVET Center (please tick
as appropriate)
[ ] Not a historical site/under construction
[ ] Historical Site
[ ] No Tertiary Education Facility / TVET Center
with BP 344 requirements in the following:(please tick
as appropriate)
[ ] Ramps
[ ] Toilet
[ ] Signages
Yes
No
7. The LGU has a local office that heads programs /
projects / activitiesfor PWDs
Persons with Disability Affairs Office (PDAO)(please tick all
applicable items)
[ ] Established office through an Ordinance
[ ] Established office through an Executive Order
[ ] Appointed PDAO Head who is PWD
[ ] Appointed PDAO Head who is not PWD
[ ] No PDAO
PDAO is headed by:
a. Position title(please supply information)
8

b. Salary Grade (please supply information)
c. Nature of appointment (please tick as appropriate) Permanent
Temporary
Designated
In case appointment is temporary, period has not
exceeded one year(please tick as appropriate)
Yes
No
d. Status of appointment(please tick as appropriate) [ ] With affixed signature of CSC Field Office (FO)
representative
[ ] Approved by LGU accredited to take final action on
[ ] Copy is transmitted to CSC for attestation
[ ] Executive Order or similar document is issued for
designation
indicate date received by the CSC:
If an Executive Order or similar document was
issued for designation, please indicate date of
approval:
e. Date of appointment(please supply information)
PDAO Head recruitment process(please tick all that
apply)
[ ] General assembly (GA) with the PWD sector was held
[ ] GA nominated at least 3 qualified applicants (for C/M
only)
[ ] Personnel Selection Board (PSB) included participant
from the PWD sector (for C/M only)
9

If PWD sector was represented in PSB proceedings,
participant was(please tick all that apply)
[ ] LGU employee with disability
[ ] GA-nominated observer
PDAO has accomplished the following (please tick all
applicable items)
[ ] AccomplishmentReport of PWD-related PPAs with at least
50% budget utilization(vs. budgetallocation)
[ ] All currently issued IDs 100% uploaded in the DOH
PRPWD
8. [For HUCs only] Presence of a Sign language interpreter
in the LGU (please tick as appropriate) [ ] At least one sign language interpreter in the LGU
[ ] At least one LGU staff trained in basic sign language
assigned in the PDAO
[ ] LGU has allotted a budget for hiring a sign language
interpreter
9 The LGU has an established Senior Citizens Center
(SCC)(please tick as appropriate) Yes
No
8.1 SCC is managed by(please tick all that apply) [ ] LGU
[ ] DSWD - Field Office
[ ] Partner - LGU
[ ] Partner - private agency / organization
Upholding Indigenous Peoples Representation in local
decision-making bodies
10(N) The LGU's IndigenousPeople mandatory
representative(please tick all applicable items) [ ] Has Certificate of Affirmation issued by the NCIP Regional
Office
[ ] Seats in the Sanggunian
[ ] Receives compensation and other regular benefits of a
Sanggunian member
[ ] Attends Sanggunian sessions as indicated in the Minutes
of the Meetings
[ ] Not applicable
10

11. [For cities with IP presence only] The LGU has an
Integration of the Ancestral Domain Sustainable
Development and Protection Plan (ADSDPP) or
components therein in the Local Development Plan (please
Yes
No
Support to decent shelter for all and low-cost housing
12. [For Cities only] The LGU has illegal dwelling units
within its jurisdiction (based on accomplished Form 2H:
Planning and Development Office)(please tick as
appropriate)
Yes
No
12.1 Percent accomplishment of CY 2022 targets for
resettlement PPAs (based on accomplished Form 2H:
Planning and Development Office)(please supply
information)
12.2 LGU effort(s) to control, prevent and/or remove
illegal dwelling units
Ordinance prohibiting illegal settlements, relocation
and/or reintegration of informal settlers(please tick as
appropriate)
Present Not
present
Has the following office or entity(please tick as
appropriate)
[ ] Local Housing Board
[ ] Local Housing Office
[ ] Task Force
Approved Local Shelter Plan, or approved Resettlement
and RelocationAction Plan(please tick as appropriate)
Present Not
present
If yes, timeline of plan (yyyy-yyyy)(please supply
information)
11

Resettlement and relocation PPAs (please tick as
appropriate)
Present
Not present
Local initiatives supporting the marginalized sectors
13 The LGU accomplished PPAs / utilized funds for the
marginalized sectors
13.1 Senior citizens
Fund utilization CY 2022 (based on accomplished Form
2A: Accountant’s Office)
a. Total amount allocated (please supply information)
b. Amount utilized (please supply information)
c. Percent utilization (please supply information)
Percent completion of PPAs (based on accomplished
Form 2H: Planning and Development Office) (please
supply information)
13.2 Personswith disabilities
Fund utilization CY 2022 (based on accomplished Form
12

supply information)
13.3 Local Council for the Protection of Children (LCPC), CY
2022 Fund
Source of fund, CY 2022 (based on accomplished Form
a. IRA amount received (please supply information)
b. Amount allocated (please supply information)
c. Percent allocation (please supply information)
Fund utilization (based on accomplished Form 2A:
Accountant's Office)
13

supply information)
14(N) The LGU has a ResidentialCare Facility (RCF) for the
vulnerablesectors
Applicable to Province and HUCs only
14.1 LGU-managed facility(please tick applicable condition) (N) DSWD-accredited
Ongoing application for DSWD-accreditation
Newly-establishedfacility, operation is less tan 1-year
Not listed in NGA data, but LGU provided valid
Certification
If DSWD-accredited, period of effectivity(please supply
information)
14.2 Partner-managed facility(please tick applicable
condition)
DSWD - Field Office
Partner - LGU
Private Social Welfare and Development Agency
Please provide period of effectivity of accreditation:
Please provide name of partner / facility:
15. Presence of support to/adoptionof the Pantawid
Pamilyang Pilipino Program(please tick as appropriate) [ ] Inclusion of 4Ps related programs and activities with
budget allocation in the Annual Investment Program
(AIP), Comprehensive Development Plan (CDP) and/or
Local Poverty Reduction Action Plan (LPRAP)
[ ] Package of supplemental intervention and support
services as agreed in the household intervention plan
provided to the graduated/exited beneficiaries
14

16. [For Cities only] Presence of Ordinance/Resolution on
the provision of services for children, families, and IPs in
street situations reflecting DSWD standards and rights-
based approaches.(please tick as appropriate)
Yes
No
Cities: No illegal dwelling units OR
at least 70% accomplishment of CY 2022 targets in
the approved City Shelter Plan or resettlement PPAs
contained in the AIP
Consideration is given to a city with an office, task
force/board or similar entity; an approved Local
Shelter Plan; OR ordinance prohibiting illegal
settlements/supporting relocation and/or reintegration
of informal settlers
If yes, please indicate the date of approval
(dd/mm/yyyy):(pleasesupply information)
Functionality of the Local Social Welfare and Development
Office
17. Implementationof Magna Carta for Public Social
Workers
Provinces, cities and municipalities must have:
15

All public social workers are provided with Magna Carta
grant benefits(please tick as appropriate)
[ ] Hazard allowance amounting to 20% of monthly basic
salary (for SWs assigned in hazardous areas)
[ ] Transportation Allowance
[ ] Housing and Living Quarters Allowance (if outside of a 50
km radius of the workstation)
[ ] Longevity Pay – 5% of the latest monthly basic pay for
every 5 years of continuous efficient and meritorious
service rendered
[ ] Clothing allowance
1. Appointed (in permanent status, and CSC-attested)
Provincial/City/ Municipal Social Welfare and
Development Officer that is a licensed and
registered social worker
2. Manual of Operations or local guidelines on a case
management system
3. All public social workers provided with Hazard
allowance amounting to 20% of monthly basic
salary (for SWs assigned in hazardous areas) AND
any one the following Magna Carta grant benefits:
● Transportation Allowance
● Housing and Living Quarters Allowance (if
outside of 50 km radius of the work station)
● Longevity Pay – 5% of latest monthly basic
pay for every 5 years of continuous
efficient and meritorious service rendered
● Clothing allowance
18 The LGU has a Local Social Welfare and Development
Office(LSWDO)
18.1 LSWDO is headed by:
DATA SOURCE/MOV:
● 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
● In case the exemption applies: PRC license of RSW
LSWDO staff
● At least one payroll in CY 2022 and CY 2023
16

Position title (please supply information)
Salary Grade (please supply information)
Temporary
Designated
[ ] Efforts to hire new LSWDO is already on-going
[ ] With designated LSWDO Head in the meantime
Yes
No
representative
designation
Date of appointment (dd/mm/yyyy)(please supply
information)
17

Registered social worker (please tick as appropriate) Yes
No, because he/she is hired prior to the enactment of RA
9433
Not a registered social worker
Validity of PRC license (please supply information)
18.2 Number of staff assisting the LSWDO with PRC license
(please supply information)
Validity of PRC license (please supply information for at
least one staff)
18.3 LSWDO has a procedure / manual of operations or
local guidelines on case management(please tick as
appropriate)
Yes
No
18.4 Use of CBMS data as a registry to update the profiles
of current beneficiaries of social development
programs(please tick as appropriate)
Yes
No FOR CITIES AND MUNICIPALITIES:
3. Use of CBMS data as a registry to update the
profiles of current beneficiaries of social development
programs
DATA SOURCE/MOV:
● CBMS database or other database/tracking system
that can help identify individuals and households
who will be beneficiaries of social protection
interventions. The active database should contain
data of the vulnerable sectors disaggregated by
age, sex, ethnicity, disability and economic status.
18

18.5 Use of other database/tracking system to identify
benefits of social protectioninterventions(please tick as
appropriate)
Yes
No
19. LGU efforts on mainstreaming social protection(please
tick as appropriate) [ ] Comprehensive Social Protection Development Report
(SPDR) is available
[ ] Submitted to the PSWDO for municipalities and
component cities
[ ] Social DevelopmentPlan based on the SPDR is integrated
in the CDP and LDIP (for profiling only)
[ ] Policy issuance on any area of recommendation of the
SPDR (for profiling only)
Provinces, cities and municipalities: Presence of a
Social Protection Development Report developed in
CY 2019 or later
For profiling in CY 2023, LGUs will also be asked data
on the:
● presence of social development plan based
on SPDR that is integrated in the CDP and
LDIP
● policy issuance on any area of
recommendations in the SPDR
DATA SOURCE/MOV:
● Social Protection Development Report in
accordance to the SP Handbook
● Social Development Plan integrated in the CDP
● Ordinance/EO implementing programs/projects
recommended by the SPDR
Providing free employment facilitation services
20. The LGU has a Public Employment Service Office
(PESO)(please tick as appropriate) Established office through an Ordinance
Established office through an Executive Order
No PESO but with designated officer
No PESO
Provinces, cities and municipalities: Established office
and a permanent PESO Manager with appropriate
Salary Grade
20.1 PESO is headed by:
19

Position Title (please supply information)
Provinces: At least SG 24 (Assistant Department
Head)
Cities:
● Special cities (Manila and Quezon City): At
least SG 25 (Assistant Department Head)
● Highly Urbanized Cities: At least SG 24
(Assistant Department Head)
● Component Cities: At least SG 23 (Assistant
Department Head)
Municipalities:
● Within Metro Manila: At least SG 23 (Assistant
Department Head)
● Outside Metro Manila (1st to 3rd income
classification): At least SG 19 (Senior
Labor and Employment Officer)
● Outside Metro Manila (4th to 6th income
classification): At least SG 16 (Labor and
Employment Officer III)
Considerations is given to an LGU with any of the
following:
(a) appointed PESO Manager (Head of Office)
with temporary status, provided that the
said temporary appointment:
- Has not exceeded one year;
- Conforms to the prescribed SG; and
- Is CSC-attested
Salary Grade (please supply information)
Temporary
Designated
Yes
No
[ ] Efforts to hire new PESO is already on-going
[ ] With designatedPESO Head in the meantime
representative
designation
Date of appointment (please supply information)
20

21. The LGU has an organized Local Development Council
(LDC)
21.1 Composition(please tick as appropriate) Constituted according to Sec. 107 of the LG Code
Not constituted per Sec. 107
Number of LDC members(please supply information)
Number of representativesfrom non-government
organizations (NGOs) (please tick as appropriate)
Percentage of NGO representation(please supply
information)
Please tick applicable condition: More than ¼ of the fully organized LDC
¼ of the fully organizedLDC
Less than ¼ of the fully organized LDC
If less than 1/4 of LDC, please tick all applicable
items:
[ ] Insufficient number of organized CSOs in the locality
[ ] Insufficient number of accredited CSOs in the locality
[ ] Others
If others is ticked, please specify:
21.2 Executive Committee(please tick as appropriate) Present Not
present
21.3 Secretariat(please tick all that apply) [ ] Constituted
[ ] Provides technical assistance, documentation of
proceedings, and preparation of reports
[ ] Tapped assistance of NGOs, academe, and / or research
institutions
21

21.4a Local Project Monitoring Committee(please tick as
appropriate)
As an organized functional committee of LDC
As a stand-alone committee
Not present
21.4b Other Sectoral or functional committees (please tick
all present committees)
[ ] Social development
[ ] Economic development
[ ] Physical/ land use/ infrastructure development
[ ] Environmentalmanagement
[ ] Institutional development
[ ] Others.
21.5 Meetings(please tick all that apply) [ ] Met at least once between CY 2022 January to June
[ ] Met at least once between CY 2022 July and December
21.6 NGO participation in LDC meetings(please tick all that
apply)
[ ] Participation recorded in meeting/s held between CY
2022 January to June
[ ] Participation recorded in meeting/s held between CY
2022 July to December
[ ] With submitted Plan of Action in CY 2022
21.7 Functions Sanggunian-approved/adopted plans and
investment programs that cover CY 2023 (please tick all
that apply)
[ ] Has Comprehensive Development Plan (CDP)
[ ] Has a Local Development Investment Program (LDIP)
[ ] Has an Annual Investment Plan (AIP)
Strengtheningpopulation services
22. The LGU has a Population Office.(please tick as
appropriate) [ ] Established office through an Ordinance
[ ] Established office through an Executive Order
[ ] No Population Office but with a designated officer or
coordinator
[ ] No Population Office
Provinces, cities and municipalities:
1. Presence of a Local Population Office
2.Appointed or designated Local Population Officer or
Coordinator
BASIS:
The PopulationOffice is headed by:
22

Position Title:(please supply information)
The LGC of 1991 enjoins provinces and cities to
establish their local population office and appoint a
population officer who shall take charge of the office
and formulate measures, develop plans and
strategies, and provide technical assistance and
support in carrying out measures to ensure the
delivery of basic services and provision of adequate
facilities relative to population development and the
promotion of responsible parenthood.
DILG Memorandum Circular 2019-100 provides
guidelines for all levels of LGUs in the implementation
of key strategies at the local level towards the
intensified implementation of the National Program on
Population and Family Planning through the
designation of Local Population Officers or
Coordinators.
23. [For Cities and 1st-3rd Mun. only] The LGU has
established a Teen Center (community or school-based)
Yes
DESCRIPTION:
The setting-up of functional and sustainable teen
centers in every city and municipality is one of the
strategies under POPCOM’s Adolescent Health and
Development Program, the overall goal of which is to
contribute to prevent early and repeated pregnancy.
No
If yes, please supply the following information:
Name of Center: (please supply information)
23

Date established (dd/mm/yyyy): (please supply
information) The characteristics of an adolescent-friendly teen
center are the following:
A. Effective leadership and management:
● The enabling environment for the
establishment of the center is facilitated by
strong support from key decision-makers and
stakeholders
● The commitments of local officials are
expressed and concretized by policy
issuances and allocation of corresponding
resources
B. Physical Characteristics
● Systems in the facility are implemented to
ensure that adolescents are knowledgeable
about their health and development needs
and how to access the services
● The Teen Center facility bears dual purpose in
the sense that it accommodates both
unstructured social interaction sessions
among different or the same teenage groups
and structured knowledge, skills and attitude
building or training workshops in a supervised
and controlled condition
● The health facility has convenient operating
hours and an adolescent-friendly environment
that maintains privacy and confidentiality
B.Community and stakeholders support and
ownership
24

DATA SOURCE/MOV:
● POPCOM report
● SGLG Monitoring Report
● Policy issuance for the creation and establishment
of a Teen Center
● AIP
[END OF SOCIAL PROTECTION AND SENSITIVITY]
25

Date: _______________________________
26

OVERALL AREA PROCESSING
Provinces, HUCs, and ICCs: Indicator No. 1 + any 2 from Indicators No. 2 to No. 8
Component Cities and Municipalities: Indicator No. 1 + any 1 from Indicators No. 2 to No. 8
CY 2023
Form CM 3.4 Health Compliance and Responsiveness
1
Form CM 3.4
Health Compliance and
Responsiveness
Province : Region :
For the RAT Members
(1) Based on your thoroughreview of documents provided by the assigned DILG Field Officers and on-sitevisit, please supply the required information or tick applicable LGU conditionunder
Column A. (2)In case of a correction/erasure, the RAT leader must affix a signature parallelto the corrected portion. (3) AFFIX SIGNATURE AT THE END OF EACH ASSESSMENTAREA, and PUT
INITIALS AT THE BOTTOM OF EACH PAGE. ONLY DULY ACCOMPLISHED FORMSARE TO BE ENCODED BY THE RFP OR PFP.
Required data LGU condition REMARKS (2023 NEW INDICATORS/SGLG
DATA SOURCE/MINIMUM REQUIREMENT)
Data is sourced from LGU Health Scorecard
(HSC) CY 2021. In case of data discrepancy,
please accomplish Change Request Form 4.2
(Health)
DATA SOURCE:
Local Government Unit Health Scorecard
(LGU HSC) CY 2021
Note: In case of inconsistency between
LGU and DOH data, LGU must fill-out
the Data Change Request (DCR) Form
for further verification. Data Change
Request shall only be accepted in
case of clerical and encoding errors. It
shall follow the process provided under
DOH Department Memorandum No.
2023-0044. Below are the acceptable
MOVs that will be presented and
submitted with the DCR:

1 (N) The LGU has 2022 complete and validated
Local Investment Plan for Health (LIPH)
Endorsed to PHO (for CC and Mun.)
Yes
No
For 2023 SGLG, Province/ HUC/ ICC,
Mun/CC with Concurred 2022 AOP
Province/ HUC/ ICC
● 2022 AOP concurred by the
CHD Director/ MOH BARMM
Minister or designated
representative not later than
December 15, 2021
Municipality/ Component City
● AOP endorsed by the Mun/ CC
Health Office and/or Mayor to the
PHO not later than December
31, 2021
LGU-NGA Data Discrepancy Check(please tick as approp Data differ; included in the accomplished Change Request Form
No data discrepancy
2 (N)The LGU has this percentage of households
with access to safely managed drinking water
services in CY 2021 (please supply information)
2

LGU-NGA Data Discrepancy Check(please tick as
appropriate) Data differ; included in the accomplished Change Request Form
No data discrepancy
Provinces, HUCs, ICCs, component
cities, and municipalities: more than or
equal to the set national target of 55%
DATA SOURCE/MOV:
Municipalities/CC
● Certification from the province
confirming receipt of the FHSIS
report within the prescribed
reporting timeline (Wednesday
of the 2nd week of January of
the succeeding year), and
● Copy of the submitted FHSIS
report (using the Updated
Master List of Households on
Environmental Health and
Sanitation, Part 1. Access to
Basic Safe Water Supply and
Use of Safely Managed
Drinking-Water Services or
Summary Table for
Environmental Health and
Sanitation Services)
3 (N)The LGU has this percentage of households
with access to safely managed sanitation
services in CY 2021 (please supply information)
equal to the set national target of 43.60%
DATA SOURCE/MOV:
Municipalities/CCs:
Copy of the Official 2021 Field Health
Service Information System (FHSIS)
report submitted to the PHO
LGU-NGA Data Discrepancy Check(please tick as
appropriate)
Data differ; included in the accomplished Change Request Form
No data discrepancy
4 (N)The LGU recorded these TB Case
Notification Rates:
3

4.1 (N) TB Case Notification Rate in CY 2020(ple
information)
TARGET: Provinces, HUCs, ICCs,
component cities, and municipalities: CY
2021 performance result is equal or
above the CY 2020 performance result
MEANS OF VERIFICATION:
Copy of the Annual TB Program Data
from the ITIS validated at national
program level
4.2 (N) TB Case Notification Rate in CY 2021(ple
information)
LGU-NGA Data Discrepancy Check (please tick a Data differ; included in the accomplished Change Request Form
No data discrepancy
5 (N) The LGU has this TB Treatment Success
Rate in CY 2021 (please supply information)
TARGET:
equal to 90% TB Treatment Success
Rate
Copy of the Annual TB Program Data
from the ITIS validated at national
program level
No data discrepancy
6 (N)The LGU has this mean stunting rate
among children under-five in CY 2021(please
supply information)
TARGET:
Provinces, HUCs, ICCs, municipalities
and component cities: at least 60-110%
OPT Plus coverage AND stunting
prevalence within the medium level of
public health significance (10 to < 20%)
or better.
Municipalities/CCs
Copy of the Consolidated Barangay OPT
Plus Results signed and with received
stamp from province for municipalities
and component cities data submission
(all types)
No data discrepancy
4

7 (N) The LGU has an institutionalized DRMM-H
system Yes
No
LGU HSC CY 2021
5

LGU-NGA Data Discrepancy Check (please tick as appro Data differ; included in the accomplished Change Request Form
No data discrepancy
Note: In case of inconsistency between
LGU and DOH data, LGU must fill-out
the Data Change Request Form for
further verification. Data Change
Request shall only be accepted in
case of clerical and encoding errors.
The process shall follow the process
provided under Department
Memorandum No. 2023-0044. Below are
the acceptable MOVs that will be
presented and submitted with the DCR:
Data Capture Form signed by the
Local Health Officer and LCE, or
Component 1: Approved, updated,
disseminated and tested DRRM-H
Plan
Acceptable MOVs:
Approved:
- signed DRRM-H plan
- endorsement memo/letter to local
government council of (DRRM/ DRRM-H
Budget Review)
Updated:
- content is up to date with latest
information on DRRM-H (ensured with
vital parts)
-reviewed annually as evidently inputted
through a “revision log”
Disseminated:
-documentation of activities that the plan
is communicated and circulated within
the level of organization
Tested:
6

-documentation of annual testing
through exercises (drills/ tabletop/
simulation activities on response among
others), program implementation
reviews, post incident evaluation, etc.
Component 2: Organized and trained
Health Emergency Response Team on
minimum required trainings
Acceptable MOVs:
Organized:
-local ordinance/executive order
establishing HERT or designating
members of the HERTs
Training in minimum required training
BLS/ SFA:
-training database of HERT on acquired
training on BLS and SFA
- training certificates of BLS and SFA or
official ID on BLS regardless of validity
Component 3: Available and
accessible health emergency
commodities within 24 hours post
impact of emergency/ disaster
Acceptable MOVs:
-logistics inventory or actual presence of
commodities
-presence of existing agreements/
protocol/ work instructions on
mobilization of commodities for quick
access in emergencies and disasters
Component 4: Health/ Emergency
Operations Center with functional
system
Acceptable MOVs:
7

-The LGU has space (may be shared
with DRRM) staff, stuff and the system to
perform the functions of an HOC/ EOC
-There is an Incident Command System
Structure that can be readily referred to,
in times of major events or incidents
- There are evidences of coordination/
collaboration with multi-agency
stakeholders/ partners
-There is available communication
devices or equipment for operations and
report generation
8 (N) The LGU has a functional Local
Epidemiology Surveillance Unit Yes
No
cities, and municipalities: Must have ALL
5 ESU components:
8

No data discrepancy
1. Ordinance or Executive Order
creating the ESU
1. ESU Staff Complement: at least
one (1) disease surveillance
officer duly trained on
applied/field epidemiology,
surveillance, and response, and
one (1) epidemiology assistant of
allied health profession
2. Distinct
organogram/organizational chart
3. Budget/work and financial plan
dedicated to the ESU or Approve
planning documents with
budgetary allotment from the
local budget
4. Processes and generates
epidemiologic reports (Disease
and Event surveillance report)
Data Capture Form signed by the
Local Health Officer and LCE or
Component 1: Ordinance or Executive
Order creating the ESU
- acceptable MOVs: copy of the
ordinance/EO
Component 2: ESU Staff Complement:
- acceptable MOVs: local
ordinance/EO designating
members of the ESU and
disease surveillance officer’s
certificate of training on
applied/field epidemiology,
surveillance, and response
Component 3: With distinct organogram
9

- acceptable MOVs: copy of the
organogram
Component 4: With budget/work and
financial plan dedicated to the ESU
- acceptable MOVs: Signed
AIP/AOP/WFP
Component 5: Processes and generates
epidemiologic reports
- acceptable MOVs: copy of
Disease and Event Surveillance
Report
[END OF HEALTH COMPLIANCE AND RESPONSIVENESS]
10

11
Date: _______________________________
Official Release of this Form: (Please affix release
stamp of DILG RO/PO
here)

Overall Processing:
● Provinces, Cities and Municipalities: Must meet Indicators 3 and 4 + any 2 from Indicators 1, 2 and 5 (DRAFT TECHNICAL NOTES)
 PASS ALL INDICATORS (DRAFT MC GUIDELINES)
Form CM 3.5
SustainableEducation
CY 2023
Form CM 3.5 Sustainable Education
Province : Region :
For the RAT Members
1. The LGU has a functional Local School Board Provinces, cities and municipalities:
1. An organized LSB that complies the
“mandatory membership provision” under
Section 98 of the LGC
Met at least once a month (or as often as necessary)
in CY 2022
DATA SOURCE/MOV:
● Executive Order or similar issuance creating
the LSB
● Minutes of the meeting of LSB in CY 2022
● Certified Form 2D accomplished by Schools
Division Superintendent or District Supervisor
to certify if monthly meetings are conducted
1. 1 LSB Composition(please tick as appropriate) Constituted according to Sec. 98 of the LG Code
Not constituted per Sec. 98
1.2 Met at least once a month in CY 2022(please tick as
appropriate)
Yes
No
2. The LGU conducted collaborative programs, activities,
and projects (PAPs) with externalpartners
Provinces, cities and municipalities: Must have at
least two (2) PAPs conducted in collaboration with
two different external partners in CY 2022
a. No. of PAPs conducted in CY 2022 (please supply
information)
1

b. PAPs conducted in CY 2022 (please tick as appropriate) [ Brigada Eskwela
]
[ Brigada Pagbasa
]
[ Gulayansa Paaralan
]
[ Sports development
]
[ Others
]
[ No PAPs conducted
]
DATA SOURCE/MOV:
● Accomplishment report signed by LGU and/or
external partner
● Partnership Agreements [e.g., Memorandum
of Agreement (MOA) and Memorandum of
Understanding (MOU
If Brigada Eskwela, pls. indicate the nature of activity (
keywords only)
If others, please specify:
Provinces, cities and municipalities: At least 85%
completion rate on either PAPs and utilization rate of
the fund intended for the CY 2022 SEF Budget as of
December 31, 2022
DATA SOURCE/MOV:
● Utilization/PPA Completion Data per Certified
Form 2D (Certification from DepEd
Representative)
3. The LGU implemented its LSB Plan completion or
utilized its SEF to support initiatives that produce
substantial impact in the improvement of quality Basic
Education delivery and performance indicators
a. Percent completion of LSB Plan as of Dec. 31, 2022 (base
on accomplished Form 2D)(please supply information)
b. Percent utilization rate of CY 2021 SEF budget as of Dec
31, 2022 (based on accomplished Form 2D)(please supply
information)
2

c. Completion or fund utilization was for the following
items(please tick all applicable items)
[
]
Operation and maintenance of public schools
● CY 2022 Accomplishment Report of LSB
Plan/SEF Budget
● CY 2022 Financial Report of LSB Plan/SEF
Budget
● Other relevant reports from concerned
government agencies
[
]
Construction and repair of school buildings
[
]
Facilitiesand equipment
[
]
Educational research
[
]
Purchase of books and periodicals
[
]
Sports development
[
]
Implementation of the National Feeding Program for und
children in public day care, kindergarten, and elementary
[
]
Others
[
]
No PAPs conducted
4. No. of LGU planned PPAs in the LDIP/AIP or SEF
Budget/LSB Plan covering CY 2023 aligned with
identified local priority education reform areas of DepEd
Division Office(pleasesupply information)
Provinces, cities and municipalities: At least 2 PAPs
for CY 2023 indicated in the LGU’s LDIP/AIP or SEF
Budget/LSB Plan that are aligned with the local
priority education reform areas of DepEd as provided
under the DEDP/SIP/AIP
DATA SOURCE/MOV:
● Certificate Form CM/P 2D (Certification from
DepEd Representative). The DepEd Division
Supervisor/District Supervisor shall identify
LGU PAPs present in the approved
investment program/SEF budget preparation
form that are aligned with the DEDP/SIP/AIP.
● LGUs to submit their LDIP and AIP to their
DepEd District/Division Office for the
issuance of Certified Form 2D.
● Approved SEF Budget Preparation Form No.
01
5. The LGU provided support to programs and projects
that promote inclusive education
3

a.No. of PAPs in CY 2022 that promote inclusive education
Provinces, cities and municipalities: At least 2 PPAs
in CY 2022 that promote inclusive education
DATA SOURCE/MOV:
● Accomplishment Report from the LGU
● DepEd reports on program implementation
review and other data from concerned DepEd
Central, Regional and Division Offices
● Other relevant reports from concerned
government agencies (e.g., NCCDA, NCIP,
DSWD, DPWH)
b.PAPs conductedare in relation to (please tick as
appropriate)
[
]
Programs for the Gifted and Talented
[
]
Programs for Learners with Disabilities
[
]
Madrasah and ALIVE Program
[
]
Indigenous People EducationProgram
[
]
Special Education
[
]
Alternative Learning System
[
]
Parent effectiveness service programs
[
]
Family or community livelihood project or similar progra
school age children’s education
[
]
Establishment and maintenance of Child Development Ce
[
]
Others
[
]
No PAPs conducted
6. [For Profiling] Improvement in Pupils' Performance
Indicators
Provinces, cities and municipalities: Data on the
following in SY 2021-2022 must be higher than SY
2020-2021:
1. Participation Rate / Net Enrollment Rate
2. Cohort Survival Rate
3. Completion Rate
4. Net Intake Rate
6.1 Presence of Out-of-School Youth SY 2020-2021(please
supply information)
6.1 Presence of Out-of-School Youth SY 2021-2022(please
supply information)
6.2 Incidence of Bullying SY 2020-2021(please supply
information)
4

6.2 Incidence of Bullying SY 2021-2022(please supply
information)
Provinces, cities and municipalities: Data on the
following in SY 2021-2022 must be lower than SY
2020-2021:
1. Presence of Out-Of-School Youth (OSY)
2. Incidence of Bullying Dropout
Rate / School Leaver Rate
DATA SOURCE/MOV:
● Data from DepEd District/ Division Office
(Certified Form 2D.2 or 2D.3 from DepEd
Representative)
● For municipalities and cities with no DepEd
City SDO and have multiple DepEd District
Offices, LPDO shall compute the
city/municipal average based on all Certified
Form 2D.3. To compute: Sum of the Rate
Recorded in each District Office / Number of
District Offices (Certified Form 2H)
● Data on participation rate in SY 2021-2022
and SY 2020-2021 from DepEd
● Data on cohort survival rate in SY 2021-2022
and SY 2020-2021 from DepEd
[END OF SUSTAINABLEEDUCATION]
5

Date: _______________________________
stamp of DILG RO/PO
here)
6

PASS ALL ON APPLICABLE INDICATORS
Form CM 3.6
Business-Friendliness and
Competitiveness
1
CY 2023
Form CM 3.6 Business-Friendliness and Competitiveness
Province : Region :
For the RAT Members
1 The LGU supports local economic development and
investment promotion through the following(please tick
all applicable items)
[
]
Established local economic development and investment
office/unit
[
]
Designated an office/unit for local economic developmen
promotion
[
]
Designated local economic development and investment
[
]
None of the above
If designated office, please indicate name of office assigned
perform the functions of a LEDIP office/unit
If designated staff, please indicate the position of staff
assigned to perform the functions of a LEDIP officer

2 The LGU has an updated Citizen’s Charter for securing
permits for new business and business renewal(please
tick all applicable items)
[
]
Visible within BusinessPermit and Licensing Office (BPL
[
]
Reflected current fees for processing
[
]
Reflected prescribed processing time for new business pe
than three (3) days
[
]
Reflected prescribed processing time for business permit
more than three (3) days
Kindly indicate the year the Citizen's Charter was last
updated:
3 The LGU has streamlined process in doing business
using Electronic Business One Stop Shop (eBOSS) (please
tick as appropriate) (please tick as appropriate)
Fully automated
Transitioning to fully automated
No
3.1 Number of steps followed prior to the release of busine
or mayor's permit per Citizens Charter (please tick as
appropriate)
1step (Online application, Online payment: Online relea
courier service)
2 steps (Online application, Online payment: Manual rele
(face to face))
3steps (Computerized: Setting an appointment/Submiss
Order Payment, and Pay and Claim)
4 steps (Computerized: Settingan appointment, Submiss
Order Payment, and Pay and Claim)
More than 4 steps
3.2 New businesses and business renewals are processed
using eBOSS for not more than three (3) days (per Certifie
Form 2B BPLO)(please tick as appropriate)
Yes
No
3.3 Has a Business One Stop Shop (BOSS) All-year round
Seasonal
None
2

Presence of Integration of Barangay Clearance on
3.4 Has integrated Barangay Clearance on BusinessPermit [ Yes Business permit process for Cities
process for Cities ]
[
]
[
Passed ordinance(S)
Passed other issuance(s)
DATA SOURCE/MOV:
Ordinance or similar issuance on the integration of
]
[
]
No
barangay clearance to the business permitting
process
BASIS:
01, ARTA-DTI-DILG-DICT JMC No. 2021-01, and RA
11032:
a) One (1) step for fully implemented eBOSS or
four (4) steps or less for transition to fully
automated
b) Not more than 3 days processing both for
new and renewal of business
c) Presence of Business One-Stop-Shop
(BOSS)
d) Fully implemented eBOSS
e) Integration of barangay clearance
4 The LGU has updated Local Economic Development
(LED) Data generated through (please tick as appropriate) Computerized tracking system/Computer-aided tracking
Manual tracking system
Kindly provide data on the following (per Certified Form 2
BPLO):
4.1 Number of new businesses
CY 2021(pleasesupply information)
4.2 Number of business renewals
3

4.3 Amount of capital investment derived from registe
new businesses
5.4 Number of employees derived from registered new
businesses and business renewals
5 The LGU has a Local Investment and Incentives Code
(LIIC) (please tick as appropriate) Yes
Passed ordinance(s) amending/revising existing Code
Formulated other related Investment Codes
No Investment and Incentive Code
If yes, please indicate year adopted
If amended/revised existing code, please indicate year
If formulated other investment-related codes (please tick
applicable items)
Public-private Partnership Code
Joint Venture (JV) Code
Philippine Economic Zone Authority (PEZA) Code
[END OF BUSINESS-FRIENDLINESS AND COMPETITIVENESS]
4

Date: _______________________________
stamp of DILG RO/PO
here)
5

PASS ALL INDICATORS
Form CM 3.7
Safety, Peace and Order
Assessmentfor the Seal of Good Local Governance (Cities/Municipalities)
CY 2023
Form CM 3.7 Safety, Peace and Order
City/Municipality of
Province
:
:
Income Class
Region
:
:
For the RAT Members
(1) Based on your thorough review of documents provided by the assigned DILG Field Officers and on-site visit, please supply the required information or tick applicable LGU condition under
Column A. (2)In case of a correction/erasure, the RAT leader must affix a signature parallel to the corrected portion. (3) AFFIX SIGNATURE AT THE END OF EACH ASSESSMENT AREA, and
PUT INITIALS AT THE BOTTOM OF EACH PAGE. ONLY DULY ACCOMPLISHED FORMS ARE TO BE ENCODED BY THE RFP OR PFP.
1(N) Passed the 2022 Peace and Order Council (POC)
Performance Audit rating (please tick as appropriate) Yes
PASSING RATE FOR POC: 70%
No
Not yet available
2(N) Received a “Highly Functional” rating in the 2022
Anti-Drug Abuse Council (ADAC) Performance Audit
Yes
No
Not yet available
HIGHLY FUNCTIONAL RATING: 85%
3 The LGU has provided logistical support to PNP
City/Municipal Police Station or Office in CY 2022 (based
on accomplished Form 2I: Local PNP
Office/Station)(please tick as appropriate)
Yes
No
4 The LGU has Barangay Peacekeeping Action Teams,
barangay tanods and/or any similar unit, that are (based
on accomplished Form CM 2I: Local PNP Office / Station)
4.1 Percent of barangays with organized unit (please suppl
information)
4.2 Percent of barangays with trained unit(please supply
information)
1

5 The LGU has an ordinance or similar issuance
regulating firecracker and other pyrotechnic
devices(please tick as appropriate)
Total ban of firecracker and other pyrotechnic devices
Designating zones for the sale, manufacture and use of fir
other pyrotechnic devices
No ordinance or similar issuance
[FOR PROFILING] The LGU recorded these Crime Solution
Efficiency Rates:
Crime volume statistics as of CY 2022(please supply
information)
Crime volume statistics as of CY 2021(please supply
information)
[END OF SAFETY, PEACE AND ORDER]
2

Date: _______________________________
stamp of DILG RO/PO
here)
3

Overall Area Processing (to pass the Environmental Management area)
● Provinces: Met items 1 and 3 under Solid Waste Management PLUS at least one of Items 6 to 7 under Wetlands and Water Management and PLUS Item 8 Park and
Green Space Development
● HUCs: Met items 1 to 5 under Solid Waste Management PLUS at least one of Items 6 to 7 under Wetlands and Water Management and PLUS Item 8 Park and Green
Space Development
● ICCs/CCs/Municipalities: Met both items 1 and 2 and any two of items 3, 4, and 5 under Solid Waste Management PLUS at least one of Items 6 to 7 under Wetlands
and Water Management and PLUS Item 8 Park and Green Space Development
DENR to provide the final area processing during the orientation.
CY 2023
Form CM 3.8
Environmental Management
Form CM 3.8 Environmental Management
Province : Region :
For the RAT Members
1 The LGU has a functional Solid Waste Management
Board (SWMB)
1

1.1 SWMB composition meets standard set under R.A. No.
9003(please tick as appropriate)
[ ] Has appropriatemembers from the LGU
[ ] With representativefrom the NGO sector
[ ] With representative from the recycling industry
[ ] With representative from the manufacturing or packaging
industry
[ ] With no NGO representative due to the absence of NGO
whose principal purpose is to promote recycling and the
protection of air and water quality
[ ] With no or incomplete private sector representatives due
to the absence of the recycling,manufacturing, and
packaging industry
1.2 SWMB convened at least once for CY 2022 (please tick
as appropriate)
Yes
No
Date of last board meeting (dd/mm/yyyy):(please
supply information)
2(N) The LGU operates or has closed an open/controlled
dumpsite(please tick as appropriate) No, the LGU never operated an open and/or controlled
dumpsite/s
Yes, there are open and/or controlled dumpsite/s
operating in the LGU
Yes, the LGU previously operatedan open and/or
controlled dumpsite/sbut has been closed
2.1 If YES, the LGU:
2.1.1 Has effected closure of open/controlled
dumpsite/s, as evidenced by the following(please tick
all that apply)
[ ] DENR-EMB Regional Office Certification of Closure
[ ] Safe Closure and Rehabilitation Plan (SCRP)
Date of closure per DENR-EMB RO Certification
2

2.1.2 Has formulated or taken steps to formulate a Safe
Closure and Rehabilitation Plan (SCRP)(please tick as
appropriate)
Yes
No
a. Date of approval (dd/mm/yyyy)(please supply
information)
b. Percent-completion of plan based on Form 2M
2.1.3 Has an operational Residual Containment Area
(RCA)(please tick as appropriate)
Yes
No
3(N) The LGU has a 10-Year Solid Waste Management Plan
(SWMP)(please tick as appropriate) Yes
No
3.1 If YES, the SWMP is(please tick as appropriate) Approved per NSWMC data
Final draft submittedfor review to NSWMC
If under review, please provide date received by
NSWMC
3.2 If YES, provide the timeframe of the SWMP
4 The LGU has access to a Materials Recovery Facility
(MRF) / storage for recyclable materials(please tick as
appropriate)
Yes
No
Cities, and municipalities: All component barangays
must be serviced by an operational MRF with a
recording system of wastes
Consideration may be given to LGUs with planned
programs on increasing operational MRFs or
expanding its operation of a single MRF servicing
multiple Barangays
4.1 If YES, percentage of barangays serviced by MRF with a
recording system either LGU-managed or partnership with
entity similar to MRF, e.g., junkshop(please supply
information)
3

4.2 If not all barangays are serviced by an MRF, there are
efforts on increasing access(please tick as appropriate)
[ ] Has proposed programs on increasing the number of
operational MRFs budgeted under the SWMP DATA SOURCE/MOV:
● Certified Form 2M from the Local
Environment and Natural Resources Office
● Photo Documentation (Certified Form 2E
DILG Field Office)
● Actual MRF
● Recording system
● If facility is in partnership with a private entity:
Memorandum of Agreement
● For clustering of MRF among barangays,
Memorandum of Understanding/ Agreement
● For Central MRF, recording system should
indicate that it can cater the recyclable and
biodegradable wastes from all its component
barangays/ cluster of barangays
[ ] Has proposed programsfor expanding its operation of a
single MRF servicing multiple barangays budgeted under
the SWMP
[ ] Other initiatives to increase access to MRF
If other initiatives to increase access to MRF, kindly
specify (please supply information)
5(N) The LGU has access to a sanitary landfill (SLF) for
final disposal (please tick as appropriate) Yes
No
5.1 If YES, LGU has access to final disposal facility through
(based on certified Form 2M)(please tick all that apply)
[ ] LGU-owned and operated Sanitary Landfill (SLF)
[ ] Partner-LGU’s SLF
[ ] Private company’s SLF
4

5.2 If NO, LGU has the following efforts to improve access
to a final disposal facility (based on certified Form 2M)
(please tick all that apply)
[ ] Operates a Temporary Residual Containment Area (RCA)
[ ] Ongoing construction of LGU’s own SLF
[ ] Proposed construction of LGU’s own SLF budgeted under
their approved SWMP
[ ] Partnership with other LGU with ongoing construction of
SLF
[ ] Other initiatives to access an authorized SLF budgeted
under their approved SWMP
[ ] Technology that addresses residual wastes officially
recognized by DENR as an alternative to SLF:
If Technology as alternative is ticked, kindly provide the
type of technology:
5.3 Percentage (%) of barangays covered by segregation
collection (please supply information)
Wetland and Water Management Provinces, cities, and municipalities must have at least
three of the following:
6 The LGU has initiatives contributing to biodiversity and
enhancement focusing on inland wetlands and water
bodies(please tick as appropriate)
Yes
No
5

6.1 If YES, the LGU has:(please tick all that apply)
1. A registry and map of wetlands and water
bodies within their administrative jurisdiction,
included in the LGU ecological profile,
CLUP/PDPFP, CDP, or LCCAP
2. Ordinance establishing wetland/s or water
body as a conservation area or with protection
purposes.
3. Integration of PAPs on biodiversity
conservation and enhancement in the Local
Development Investment Program or Annual
Investment Program covering CY 2023
4. Management plan for an inland wetland or
waterbody
5. Wetland information sheet with the profile and
assessment of the wetland/waterbody
prepared in coordination with DENR
6. Program or project conducted on biodiversity
and conservation or water management in CY
2022 or 2023
[ ] Registry and map of all wetlands and water bodies within
their administrative jurisdiction, included in the LGU
ecological profile, CLUP, CDP, or LCCAP
[ ] Ordinance establishing wetland/s or water body as a
conservation area or with protection purposes
[ ] Integration of PAPs on biodiversity conservation and
enhancement in the Local Development Investment
Program or Annual Investment Program covering CY 2023
[ ] Management plan for an inland wetland or waterbody
[ ] Wetland information sheet with the profile and
assessment of the wetland/waterbody prepared in
coordination with DENR
[ ] Program or project conducted on biodiversity and
conservation or water management in CY 2022 or 2023
L
in
D
GUs with all the above efforts will have a green mark
their Governance Assessment Report.
ATA SOURCE/MOV:
● Ordinance establishing wetland/s or water
body as conservation area or with protection
purposes
● Ecological Profile
● Relevant comprehensive and thematic plans
and investment programs that should be
approved/ adopted by the LGU (e.g., PDPFP,
CLUP, CDP, LCCAP, LDIP, AIP)
● Sanggunian-adopted/ approved Management
plan for an inland wetland or waterbody
● Accomplishment report on th program or
project conducted on biodiversity and
6

conservation or water quality management in
CY 2022 or 2023
Wetland information sheet (technical assistance from
DENR regional offices)
7 The LGU has initiatives on Water Quality Management
Yes
Provinces, cities, and municipalities: At least two of the
following:
1. Annual Water Quality Monitoring Results of a
water a body indicating the water quality within
the river classification
2. Water quality monitoring unit created with
monitoring capabilities
3. Water quality management and monitoring
PAPs in the LDIP or AIP covering CY 2023
4. Compliance scheme or localized Water
Quality Management Area Action Plan (for
LGU WQMA Members)
LGUs with all the above efforts will have a green mark
in their Governance Assessment Report.
DATA SOURCE/MOV:
● WQMA Accomplishment Report (for LGU
WQMA Members)
● Compliance scheme or localized Water
Quality Management Area Action Plan (for
LGU WQMA Members)
● WQMA Governing Board Resolution
● EO or other issuance creating the Water
Quality Monitoring Unit
● Annual Water Quality Monitoring Results
● AIP
● LDIP
No
7.1 If YES, the LGU has:(please tick all that apply) [ ] Annual Water Quality Monitoring Results of a water body
indicating the water quality within the river classification
[ ] Water quality monitoring unit created with monitoring
capabilities
[ ] Water quality management and monitoring PAPs in the
LDIP or AIP covering CY 2023
[ ] Compliance scheme or localized Water Quality
Management Area Action Plan(for LGU WQMA Members)
7

Parks and Green Spaces Development
Provinces, cities and municipalities: At least three of
the following:
1. At least one public park or green space
maintained by the LGU
2. List and map of public parks and green
spaces in their jurisdictions should be included
in the Ecological Profile or CLUP or PDPFP
3. Integration of PAPs for public parks and green
spaces development/ maintenance in the
LDIP or AIP covering CY 2023
4. Site profile and assessment of at least one
public park or green space
LGUs with all the above efforts will have a green mark
in their Governance Assessment Report.
DENR to provide the final area processing during the
orientation.
DATA SOURCE/MOV:
● Ecological Profile
● CLUP
● Ordinance supporting the establishment and
maintenance of a public park/green open
space
● AIP
● Site profile and assessment of public parks
and green spaces
● Accomplishment Report of Program or project
conducted for public parks and green spaces
8. Establishment or Maintenance of Public Parks and
Green Spaces(please tick all that apply) [ ] At least one public parks or green spaces maintained by
the LGU
[ ] List and map of public parks and green spaces in their
jurisdiction should be included in the Ecological Profile or
CLUP
[ ] Integration of PAPs for public parks and green spaces
development/maintenance in the Local Development
Investment Program or Annual Investment Program
covering CY 2023
[ ] Site Profile and Assessment of at least one public park or
green spaces
8
[END OF ENVIRONMENTAL MANAGEMENT

Date: _______________________________
9

OVER ALL PROCESSING
TOURISM DEVELOPMENT: ANY THREE (3) OUT OF FOUR (4) INDICATORS
CULTURAL HERITAGE: ANY THREE (3) OUT FOUR (4) INDICATORS
CY 2023
Form CM 3.9
Tourism, Heritage
Development, Culture and Arts
Form CM 3.9 Tourism, Heritage Development, Culture and Arts
Province : Region :
For the RAT Members
TOURISM DEVELOPMENT
1. The LGU has a tourism officer who holds the following
position(please tick as appropriate)
Permanent
Temporary
Designated
None
2 The LGU has a tourist information and assistance
center/desk (based on accomplished Form 2E: DILG Field
Office)(please tick as appropriate)
Yes
No
3. The LGU has a Local Tourism Plan For provinces, cities, and municipalities: Must have at
least one of the following documents:
3.1 Approved Local Tourism Plan(please tick as appropriate) Yes
No
1

3.2 Tourism Development Plan Committee or Technical
Working Group(please tick as appropriate)
Executive Order 1. Approved resolution or executive order creating
the Tourism Development Plan Committee or
Technical Working Group
2. Approved Work plan for the formulation of the
Tourism Development Plan
3. Draft Local Tourism Development Plan
ADDITIONAL MOV:
Documentation supporting the planning and formulation
of the Local Tourism Development Plan.
Ordinance
None of the Above
3.3 Approved Work Plan for the formulation of the Tourism
Development Plan(please tick as appropriate)
Yes
No
Not applicable
3.4 Draft Local Tourism Development Plan(please tick as
appropriate)
Yes
No
Not applicable
4. [N] The LGU has submitted its Annual Supply Tourism
Statistics Report for CY 2022, based on the DOT standard
reporting format under SLTSS, to DOT Regional/Central
Office(please tick as appropritate)
Yes
No
For provinces, cities, and municipalities:
Must have submitted annual supply tourism statistics
report for CY 2022, based on the standard format under
the SLTSS, to DOT Regional Office.
DATA SOURCE/MOV:
Actual Supply database based on the DOT Standard
Reporting Format under the Standard Local Tourism
Statistics System (SLTSS) – submitted to DOT Regional
and Central Office
● Supply Database for Accommodation
Establishments (SAE1)
● Supply Database for Tourist Attractions (STA)
● Supply Database for other Tourism Enterprises
(STE)
Documentation of submitted report at least to the DOT
Regional Office
If yes, please indicate date submitted(dd/mm/yyyy)(please
supply information)
CULTURAL HERITAGE PROMOTION AND CONSERVATION
5 The LGU has a local council for culture and the arts(please
Yes
No
2

5.1 If YES, please indicate date constituted
6 The LGU appropriated budget for the conservation and
preservation of cultural property in CY 2022, as of
December 31, 2022(please tick as appropriate)
Yes
No
If yes, please supply information:
Amount allocated
Amount utilized
Percentutilization
7 The LGU has a cultural property inventory / registry,
using the templates provided in DILG-NCCA JMC No. 2021-
001, and updated not earlier than 2022(please tick as
appropriate)
Yes
No
Provinces, cities and municipalities: Cultural inventory
that is:
1. Updated not earlier than 2022,
2. Using the templates prescribed under DILG-
NCCA JMC No. 2021-001,
3. Adopted by the LGU, and
4. Submitted to NCCA for review.
Consideration is given to LGUs with cultural inventory
using the templates prescribed under DILG-NCCA JMC
No. 2021-001 that is updated not earlier than 2022,
transmitted to NCCA for review, but is yet to be adopted
by the LGU.
DATA SOURCE/MOV:
● Cultural property inventory using the templates
prescribed under DILG-NCCA JMC No. 2021-001
● Acknowledgement letter from NCCA
● List of LGUs with inventory submission from NCCA
7.2 Date last updated(dd/mm/yyyy)(please supply
information)
7.3 Adopted by the Sanggunian through the following
instrument(please tick as appropriate)
Ordinance
Resolution
None of the above
Date adopted (dd/mm/yyyy):(please supply information)
7.4 Date submitted to NCCA for review
8 The LGU‘s history and culture is documented and
published through the followingmedia
8.1 LGU’s official website(please tick as appropriate) Yes
No
8.2 Magazines / newsletters(please tick as appropriate) Yes
No
3

8.3 Books(please tick as appropriate) Yes
No
8.4 Digital media(please tick as appropriate) Yes
No
If yes, please specify digital media format(please supply
information)
8.5 Other form(please tick as appropriate) Yes
No
If yes, please specify:
[END OF TOURISM, HERITAGE DEVELOPMENT, CULTURE AND ARTS]
4

Date: _______________________________
5

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