Brigada-Eskwela-Blank-Forms (1).doc

8/16/2019 Brigada-Eskwela-Blank-Forms (1).doc

1/16

BE Form 01

Republic of the PhilippinesDepartment of EducationRegion IV-A A!ABAR"#$

SCHOOLS DIVISION OF BATANGAS PROVINCE

LUCSUHIN NATIONAL HIGH SCHOOL!ucsuhin%alatagan%Batangas

&chool 'ear (01)-(01*

BRIGADA ESKWELA

PHYSICAL FACILITIES AND MAINTENANCE NEEDS ASSESSMENT FORM

Instruction+ onduct an ocular inspection of the school ph,sical listed belo. /hen proide the needed information to facilitate theimproement to be done on these identied facilities. 2If needed ,ou ma, use separate forms for each classroom or school facilit,3.

FACILITIES

CONDITION(Check One)

Rem!k"N#$!e %&

'm!%emen#Nee*e*

(e+,+ !e'!-!e'n#'n,-

!e.cemen#-e#c)

M#e!'.Re"%$!ce"

Nee*e* (In*'c#ek'n* n* /$.'#0)

Mn%1e!Nee*e*(In*'c#e

/$n#'#0 n*n#$!e %& .2%!

"e!'ce" nee*e*

S#'"&c#%!0

Un"#'"&c#%!0

I& Un"#'"&c#%!0-

*e"c!'2e #he!%2.em

• Roofs45utters

• eilings

• 6alls

•

Blac7boards• hairs4des7s4tables

• 6ater facilities4Drainage &,stem

• &ignages


2/16

• &chool garden

FAI!I/IE&

#$DI/I#$ 2hec7 #ne3

Remar7s $ature ofImproement

$eeded2e.g. repair%repainting%

replacement3

8aterial Resources$eeded 2Indicate7ind and 9ualit,3

8anpoer $eeded2Indicate 9uantit,

and nature of laboserices needed3

&atisfactor,

:nsatisfactor,

If :nsatisfactor,%describe the

problem

• !ighting

• 6indos

•

Doors• omfort Rooms

• &chool 5rounds

• &chool anteen4linic

• &chool Fence4 all

• Electricit,

• Alternatie gate

• Reference 8aterials

• !aborator, e9uipment

Prepared b,+ $oted+

MARDY SON PUN3ALAN ;;;;;;;;;;;;;;;;; BENITO C+ HERNANDE3

&chool Ph,sical Facilities oordinator Date of Inspection &chool


3/16

BE Form 0(




&chool 'ear (01)-(01*

BRIGADA ESKWELASCHOOL WORK PLAN

Instruction+ !ist don all the specic actiities that ,ou ill be underta7ing in relation to the conduct of Brigada Es7ela in ,our schooland ll in the re9uired information. Add another sheet if needed. #nce completed% submit a cop, to the adopt-A-&chool Program coordinator orBrigada Es7ela coordinator of ,our diision on or before ;;;;;;;;;.

KRA Ac#''#'e" T'me.'ne Pe!"%n4"

Re"%n"'2.e

M#e!'."

Nee*e*

B$*,e#

1.Adocac, and8ar7eting

(.Resource8obili=ation

>. Implementation

?. 8onitoring andEaluation

@. Reporting

Prepared b,+ $oted b,+

AMIE B+ BUCO ;;;;;;;;;;;;;;;;;;;;;;;;; ;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;


4/16

&ignature oer Printed name Date Prepared A&P Diision oordinator4 BE coordinator

BE Form 0>




&chool 'ear (01)-(01*

BRIGADA ESKWELARESOURCE MOBILI3ATION FORM

Instruction+ :sing the completed BE Form 01+ Ph,sical Facilities $eeds Assessment as basis% summari=e the resources 2materials andmanpoer3 needed and list don the potential source or partners to be tapped. Add additional sheet if needed. /he &tatus and Remar7scolumns should be updated regularl, to determine progress in ac9uiring resources needed.

M#e!'." Nee*e* 5$n#'#0

Ke0Pe!"%n"6O!,n'7#'%n

#%2e Te*

S#!#e,'e"6P.n%&

Ac#'%nPe!"%n Re"%n"'2.e S##$" Rem!k"


5/16

L2%!Sk'.."6V%.$n#ee!"

Nee*e*5$n#'#0

Ke0Pe!"%n"6O!,n'7#'%n

#%2e Te*

S#!#e,'e"6P.n%&

Ac#'%nPe!"%n Re"%n"'2.e S##$" Rem!k"

Prepared b,+ $oted+

;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;; BENITO C+ HERNANDE3

Resource 8obili=ation ommittee hairperson Principal IV


6/16

BE Form 0?




&chool 'ear (01)-(01*

BRIGADA ESKWELADAILY ATTENDANCE OF VOLUNTEERS

Date+ ;;;;;;;;;;;;;;;;;;;;

Instruction+ Volunteers themseles should personall, ll in the details re9uired b, this form under the superision of an, of thecommittee members. For the last column% indicate if masonr,% carpentr,% plumbing% painting% electrical% gardening4landscaping% ordinar,labours or others.

NAME POSITION6DESIGNATION

ADDRESS6ORGANI3ATION6

AFFILIATION

CONTACTNUMBER

TIME SIGNATURE

TOTALNUMBERS

OFHOURSSERVED

8NATUREOF

VOLUNTEERSERVICESRENDERED

IN OUT


7/16

$oted+BENITO C+ HERNANDE3 ;;;;;;;;;;;;;;;;;;;;;;

Principal IV Date

BE Form 0@




&chool 'ear (01)-(01*

BRIGADA ESKWELARECORD OF DONATIONS RECEIVED

ITEMS6 MATERIALS 5UANTITY DATERECIEVED

NAME OF DONOR ASSUMED COST OF ITEMSPe! Un'# T%#.

TOTAL


8/16


;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;; BENITO C+ HERNANDE3

ommittee on Documentation hair48ember Principal IV

BE Form 0)




&chool 'ear (01)-(01*

BRIGADA ESKWELADAILY ACCOMPLISHMENT REPORT

DA' 1 ( > ? @)

DA/E+ ;;;;;;;;;;;;;;;;;

Instruction+ !ist don all the actiities that needs to be underta7en for each da, of the Brigada Es7ela ee7. At the end of each da,%please mar7 the appropriate column that corresponds to the status of each actiit,. ite reasons for non-completion.

Ac#''#'e"

STATUSREMARKS6RECOMMENDATIONS

C%m.e#e*S#!#e* 2$# n%#

0e#c%m.e#e*

N%# *%ne

D0 9D0 :D0 ;D0 <D0 =


9/16

D0 >


;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;; ;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;

Program Implementation ommittee hair48ember &chool


10/16

SCHOOL HEAD? #$/A/ $#.+PTA PRESIDENT? #$/A/ $#.+

BE Form 0*




&chool 'ear (01)-(01*

A+ SCOPE OR REPAIR AND MAINTENANCE WORK COMPLETED (P.e"e check !%!'#e c%.$mn)Wh# 1" *%ne

Re'!e* Re'n#e* Re.ce*O#he!"

(B!'e& De"c!'#'%n)9+R%%&":+Ce'.'n,";+W..


11/16

BE Form 0*




&chool 'ear (01)-(01*

B+ DONATIONS6MATERIALS RESOURCES GENERATED (U"e "e!#e "hee#"- '& nee*e*) /,pe of Donations S%$!ce" E"#'m#e* C%"#


12/16

TOTAL

BE Form 0*




&chool 'ear (01)-(01*

C+ VOLUNTEERS SERVICE

T0e %& V%.$n#ee!Nme %& 'n*''*$."6

%!,n'7#'%n

N$m2e! %& V%.$n#ee!"

D0 9 D0 : D0 ; D0 < D0 = D0 > TOTAL

TOTAL


13/16

BE Form 0*Republic of the PhilippinesDepartment of EducationRegion IV-A A!ABAR"#$



&.'. (01)-(01*

D+ ESTIMATED COST OF VOLUNTEER SERVICES RENDEREDT0e %& Se!'ce T%#. N$m2e! %& V%.$n#ee!" T%#. N$m2e! %& H%$!"

Ren*e!e*T%#. E"#'m#e* C%"#"

C!en#!0M"%n!0G!*en'n,6 Ln*"c'n,P'n#'n,We.*'n,E.ec#!'c.6 E.ec#!%n'c"P.$m2'n,O!*'n!0 L2%!

TOTAL


14/16

BE Form 07




E+ SIGNIFICANT EVENTS 6 EPERIENCES

Wh# hene* Wh% 1e!e 'n%.e* WhenWh# '"6!e 'm%!#n#c%n#!'2$#'%n #% #he %e!#'%n

#% #he "ch%%. %! #% e@'"#'n,nee*" %& #he "ch%%.

•


15/16

BE Form 0*Republic of the PhilippinesDepartment of EducationRegion IV-A A!ABAR"#$



F+ LESSONS LEARNED

G. SUGGESTIONS TO STRENGTHEN BRIGADA ESKWELA PROJECT


16/16

P!e!e* 20?

BENITO C+ HERNANDE3P!'nc'. IV

D#e?

Documents

Brigada-Eskwela-Blank-Forms (1).doc