SGLGB Data Capture Form - 2022 - v2
SGLGB Data Capture Form - 2022 - v2
SGLGB Data Capture Form - 2022 - v2
1
2022 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY
Year Under Review: CY 2020
Data Capture Form
As of _______________ 2022
Identifying Information
Region : _______________________________
Barangay : _______________________________
City/Municipality : _______________________________
Province : _______________________________
Page 2 of 28
SGLGB Form No. 1
2022 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY
Year Under Review: CY 2020
Data Capture Form
As of _______________ 2022
1
No data = 0
5. Maintenance of Presence of RBI RBI form A of Barangay With RBI: 1 1
Record of Barangay DILG MC No. Secretary
● Yes = 1
Inhabitants (RBI) 2008-144 validated
by the Punong ● No = 0
Barangay
Certification from
the Punong
Barangay
Date of last
update: _______
Page 3 of 28
SGLGB Form No. 1
2022 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY
Year Under Review: CY 2020
Data Capture Form
As of _______________ 2022
No = 0
7. Mechanisms on the Organization of the EO or similar Barangay With EO or 2 2
Prevention and Barangay Health issuance on the Secretary similar
Control of COVID-19 Emergency organization of issuance:
Response Teams BHERTs
Yes = 2
(BHERTs)
No = 0
Provision of Budget Enacted With 1 1
to implement Ordinance Ordinance:
COVID-19 related
Yes = 1
interventions
No = 0
Bonus Point: Enacted Ordinance With Ordinance:
Yes = 1
No = 0
Enactment of
Ordinance on the
Enforcement of the
Minimum Public
Health Safety
Protocols or similar
measures to deter the
spread of COVID-19
TOTAL 20 16
Page 4 of 28
SGLGB Form No. 1
2022 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY
Year Under Review: CY 2020
Data Capture Form
As of _______________ 2022
=0
● No data = 0
Presence of a BFDP Board With BFDP Board: 3 3
Yes = 3
No = 0
Location of the BFDP
Board:
_____________________
_
Page 7 of 28
SGLGB Form No. 1
2022 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY
Year Under Review: CY 2020
Data Capture Form
As of _______________ 2022
Page 8 of 28
SGLGB Form No. 1
2022 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY
Year Under Review: CY 2020
Data Capture Form
As of _______________ 2022
CY 2020 No = 0
TOTAL 20 18
Page 9 of 28
SGLGB Form No. 1
2022 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY
Year Under Review: CY 2020
Data Capture Form
As of _______________ 2022
meeting
● 4 out of 4 = 2
● 2 or 3 out of
4=1
● 1 out of 4 = 0
● No = 0
No data = 0
Financial Utilization BDRRM Plan BDRRMC Financial 1 1
of the 70% Utilization of the
component of the 70% BDRRM
BDRRM Fund Accomplishment C/MDRRMO Fund:
report showing the
● 50% and
financial utilization
above = 1
rate of the 70%
component of the ● Less than
BDRRM Fund 50% = 0.5
● No data = 0
Physical BDRRM Plan BDRRMC Accomplishment 3 2
Accomplishment Rate of the
Accomplishment
Rate of the BDRRM Activities/Project
Report showing
Plan C/MDRRMO s Reflected in
the physical
the BDRRM
accomplishment
Plan:
● 70% and
Page 11 of 28
SGLGB Form No. 1
2022 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY
Year Under Review: CY 2020
Data Capture Form
As of _______________ 2022
above = 3
● 50 – 69% =
2
● 20 – 49% =
1
● 19% and
Below = 0
2. Extent of risk With drills Post-Activity Barangay Initiated by 1 0.5
assessment and conducted Report Secretary/BDR the Barangay
Early Warning RMC =1
System (EWS) Initiated by
Certification from the C/M or
the C/MDRRMO C/MDRRMO other
agencies =
0.5
With Post- 1 1
Activity Report:
Yes = 1
No = 0
Presence of Local Local Risk Map Barangay With Local risk 1 1
Risk Map certified by the Secretary/BDR map:
C/MDRRMO RMC
● Yes = 1
● No = 0
C/MDRRMO
Page 12 of 28
SGLGB Form No. 1
2022 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY
Year Under Review: CY 2020
Data Capture Form
As of _______________ 2022
C/MDRRMO
3. Extent of Presence of EO or similar Barangay With EO or 1 1
preparedness for Barangay issuance creating Secretary/BDR similar
effective response Emergency BERTs RMC issuance:
and recovery Response Team/s
● Yes = 1
(BERTs)
Total number of ● No = 0
BERTs:
_________
Designated/
Evacuation Center
location :
_______________
_____________
Presence of Photos of Disaster Barangay Disaster 3 2.5
Disaster Response Response Secretary/BDR Response
Equipment/Supplies Equipment/Supplie RMC Equipment/Sup
s certified by the plies:
Punong Barangay
● 2-way radio /
mobile
phone = 0.5
● Rescue
vehicle/Bara
ngay patrol =
0.5
● Portable
Generator or
alternative
source of
electricity =
0.5
● First aid kit/
Flashlight =
0.5
Page 14 of 28
SGLGB Form No. 1
2022 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY
Year Under Review: CY 2020
Data Capture Form
As of _______________ 2022
● Personal
Protective
Equipment
(PPE) = 0.5
● Megaphone
= 0.5
TOTAL 20 17
Page 16 of 28
SGLGB Form No. 1
2022 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY
Year Under Review: CY 2020
Data Capture Form
As of _______________ 2022
Location: ● None = 0
Status of BHS/C
(check the
corresponding
answer)
____ Barangay
owned/maintained
____ With access
to other BHS/C
Availability of services in Certification from Barangay ● Expanded 2 1
the BHS/C the C/M Health Secretary Program on
Officer stating that Immunization
services are (EPI) = 0.5
available in the C/M Health
● Maternal Care
BHS/C Officer
= 0.5
● Nutrition Care
= 0.5
● Other Services
= 0.5
● None = 0
3. Functionality of the Functionality of the BDC Annex 3 (C/M Audit Barangay If the result is: 1 1
Page 18 of 28
SGLGB Form No. 1
2022 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY
Year Under Review: CY 2020
Data Capture Form
As of _______________ 2022
Page 19 of 28
SGLGB Form No. 1
2022 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY
Year Under Review: CY 2020
Data Capture Form
As of _______________ 2022
Page 20 of 28
SGLGB Form No. 1
2022 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY
Year Under Review: CY 2020
Data Capture Form
As of _______________ 2022
7. Functionality of the Level of Functionality DILG MC No. 2008- Barangay If the result is: 1 1
Barangay Council obtained 126 dated August Secretary
● Ideal = 1
for the Protection of 21, 2008
Children (BCPC) ● Mature = 0.5
● LCPC Form 1-A
● Progressive =
0.25
● Basic = 0.15
● No
Page 21 of 28
SGLGB Form No. 1
2022 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY
Year Under Review: CY 2020
Data Capture Form
As of _______________ 2022
Functionality =
0
8. Mechanism for Provision of funds to Approved GAD Barangay With approved 0.5 0.5
Gender and GAD Plan and Budget Secretary GAD Plan and
Development (GAD) reviewed and Budget:
endorsed by the
Yes = 0.5
DILG Field Office
No = 0
Creation of a GAD Focal EO or similar With EO or similar 0.5 0.5
Point System issuance creating issuance:
the GAD Focal
Yes = 0.5
Point System
No = 0
TOTAL 15 13
Page 22 of 28
SGLGB Form No. 1
2022 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY
Year Under Review: CY 2020
Data Capture Form
As of _______________ 2022
and locational
clearance
purposes
4. Issuance of Presence of a Picture of the Barangay With Citizens’ 4 4
Barangay Citizens’ Charter in Citizens’ Charter Secretary/Trea Charter (for the
Clearance1 not the barangay hall (for the issuance of surer issuance of
covered by DILG barangay barangay
MC No. 2019-177 clearance only) clearance only):
such as: certified by the
● Yes = 4
residency, Barangay
indigency, etc, Secretary ● No = 0
within seven (7)
working days
TOTAL 15 13
1
Item 5.1 of DILG MC No. 2019-177 dated October 17, 2019 – Barangay Clearance refers to any and all documents issued by the barangays with or without corresponding fees as defined in their
ordinances relative to or in relation to the issuance of business permit and locational clearance by the city/municipality or any other permit as may be required.
Page 24 of 28
SGLGB Form No. 1
2022 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY
Year Under Review: CY 2020
Data Capture Form
As of _______________ 2022
(check the
corresponding
answer)
____ Barangay
Page 25 of 28
SGLGB Form No. 1
2022 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY
Year Under Review: CY 2020
Data Capture Form
As of _______________ 2022
owned
____ Clustered
Brgys
____ With MOA
with junk shops
● Location of
MRF
_____________
Page 27 of 28
SGLGB Form No. 1
2022 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY
Year Under Review: CY 2020
Data Capture Form
As of _______________ 2022
Page 28 of 28