Brigada Eskwela Blank Forms

BE Form 01
Republic of the Philippines

Department of Education
Region IV-A CALABARZON
SCHOOLS DIVISION OF BATANGAS PROVINCE
LUCSUHIN NATIONAL HIGH SCHOOL
Lucsuhin,Calatagan,Batangas
School Year 2016-2017
BRIGADA ESKWELA
PHYSICAL FACILITIES AND MAINTENANCE NEEDS ASSESSMENT FORM
Instruction: Conduct an ocular inspection of the school physical listed below. Then provide the needed information to facilitate the
improvement to be done on these identified facilities. (If needed you may use separate forms for each classroom or school facility).
CONDITION
(Check One)
FACILITIES
Roofs/Gutters
Ceilings
Walls
Blackboards
Chairs/desks/tables
Water facilities/
Drainage System
Signages
Satisfacto
ry
Unsatisfact
ory
Remarks
If
Unsatisfactory,
describe the
problem
Nature of
improvement
Needed
(e.g. repair,
repainting,
replacement,
etc)
Material
Resources
Needed (Indicate
kind and quality)
Manpower
Needed(Indicate
quantity and
nature of labor
services needed)
School garden
FACILITIES
CONDITION
(Check One)
Satisfactor Unsatisfactor
y
y
Remarks
If Unsatisfactory,
describe the
problem
Nature of
Improvement
Needed
(e.g. repair,
repainting,
replacement)
Material Resources
Needed (Indicate
kind and quality)
Manpower Needed
(Indicate quantity
and nature of labor
services needed)
Lighting
Windows
Doors
Comfort Rooms
School Grounds
School Canteen/Clinic
School Fence/ wall
Electricity
Alternative gate
Reference Materials
Laboratory equipment
Prepared by:
MARDY SON PUNZALAN
School Physical Facilities Coordinator
Noted:
_________________
Date of Inspection
BENITO C. HERNANDEZ
School Head
BE Form 02

BRIGADA ESKWELA
SCHOOL WORK PLAN
Instruction: List down all the specific activities that you will be undertaking in relation to the conduct of Brigada Eskwela in your school
and fill in the required information. Add another sheet if needed. Once completed, submit a copy to the adopt-A-School Program coordinator or
Brigada Eskwela coordinator of your division on or before _________.
KRA
Activities
Timeline
Persons
Responsible
1.Advocacy and
Marketing
2.Resource
Mobilization
3. Implementation
4. Monitoring and
Evaluation
5. Reporting
Prepared by:
AMIE B. BUCO
__________________________________________
Noted by:
_________________________
Materials
Needed
Budget
Signature over Printed name
Date Prepared
ASP Division Coordinator/ BE coordinator
BE Form 03

BRIGADA ESKWELA
RESOURCE MOBILIZATION FORM
Instruction: Using the completed BE Form 01: Physical Facilities Needs Assessment as basis, summarize the resources (materials and
manpower) needed and list down the potential source or partners to be tapped. Add additional sheet if needed. The Status and Remarks
columns should be updated regularly to determine progress in acquiring resources needed.
Materials Needed
Quantity
Key
Persons/Organization
to
be Tapped
Strategies/Plan
of
Action
Person Responsible
Status
Remarks
Labor
Skills/Volunteers
Needed
Quantity
Key
Persons/Organization
to
be Tapped
Prepared by:
___________________________________________
Resource Mobilization Committee Chairperson
Strategies/Plan
of
Action
Person Responsible
Status
Noted:
BENITO C. HERNANDEZ
Principal IV
Remarks
BE Form 04

BRIGADA ESKWELA
DAILY ATTENDANCE OF VOLUNTEERS
Date: ____________________
Instruction: Volunteers themselves should personally fill in the details required by this form under the supervision of any of the
committee members. For the last column, indicate if masonry, carpentry, plumbing, painting, electrical, gardening/landscaping, ordinary
labours or others.
NAME
POSITION/
DESIGNATION
ADDRESS/
ORGANIZATION/
AFFILIATION
CONTACT
NUMBER
TIME
IN
OU
T
SIGNATUR
E
TOTAL
NUMBERS
OF
HOURS
SERVED
NATURE
OF
VOLUNTEER
SERVICES
RENDERED
Noted:
BENITO C. HERNANDEZ
______________________
Principal IV
Date
BE Form 05

BRIGADA ESKWELA
RECORD OF DONATIONS RECEIVED
ITEMS/ MATERIALS
QUANTITY
DATE
RECIEVED
NAME OF DONOR
ASSUMED COST OF ITEMS

Per Unit
Total
TOTAL
Prepared by:
Noted by:
________________________________________________
BENITO C. HERNANDEZ
Committee on Documentation Chair/Member
Principal IV
BE Form 06

BRIGADA ESKWELA
DAILY ACCOMPLISHMENT REPORT
DAY
6
DATE: _________________
Instruction: List down all the activities that needs to be undertaken for each day of the Brigada Eskwela week. At the end of each day,
please mark the appropriate column that corresponds to the status of each activity. Cite reasons for non-completion.
Activities
Day
Day
Day
Day
Day
1
2
3
4
5
Completed
STATUS
Started but not
yet
completed
REMARKS/RECOMMENDATIONS
Not done
Day 6
Prepared by:
Noted by:
________________________________________________
______________________________________________
Program Implementation Committee Chair/Member
School Head
Date Prepared: ____________

BE Form 7

BRIGADA ESKWELA
SCHOOL ACCOMPLISHMENT REPORT
DIVISION: BATANGAS PROVINCE
REGION: IIV-A CALABARZON
SCHOOL: LUCSUHIN NATIONAL HIGH SCHOOL
SCHOOL ID: 301111
SCHOOL ADDRESS: LUCSUHIN,CALATAGAN,BATANGAS
(Please check appropriate box)
Level:
Elementary
High School
Type of School:
Central School
Non- Central School
(Complete)
Multi-grade
Primary School
(Complete)
Integrated
SCHOOL HEAD:
PTA PRESIDENT:
CONTACT NO.:
CONTACT NO.:
BE Form 07

A. SCOPE OR REPAIR AND MAINTENANCE WORK COMPLETED (Please check appropriate column)
What was done?
Repaired
1.Roofs
2.Ceilings
3.Wall
4.Windows and Doors
5.Chairs/Desks, Tables and Blackboards
6.Comfort Rooms
7.Leaking Pipes
8.School Grounds/Landscaping
9.School signs
10. Alternative gates/ backdoor gates
11.Electric fans
12.Lightings
Repainted
Replaced
Others
(Brief Description)
BE Form 07

B. DONATIONS/MATERIALS RESOURCES GENERATED (Use separate sheets, if needed)
Type of Donations
Sources
Estimated Cost
TOTAL
BE Form 07

C. VOLUNTEERS SERVICE
Type of Volunteer
Name of individuals/
organization
TOTAL
Number of Volunteers
Day 1
Day 2
Day 3
Day 4
Day 5
Day 6
TOTAL
BE Form 07

S.Y. 2016-2017
D. ESTIMATED COST OF VOLUNTEER SERVICES RENDERED

Type of Service
Total Number of Volunteers
Carpentry
Masonry
Gardening/ Landscaping
Painting
Welding
Electrical/ Electronics
Plumbing
Ordinary Labor
TOTAL
Total Number of Hours

Rendered
Total Estimated Costs
BE Form 07
E. SIGNIFICANT EVENTS / EXPERIENCES

What happened?
Who were involved?
What is/are important

contribution to the operation
to the school or to existing
needs of the school?
When?
BE Form 07

F. LESSONS LEARNED
G. SUGGESTIONS TO STRENGTHEN BRIGADA ESKWELA PROJECT
Prepared by:
Date:
_____________________________
BENITO C. HERNANDEZ
Principal IV

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BE Form 01

Republic of the Philippines

Republic of the Philippines

Signature over Printed name

ASP Division Coordinator/ BE coordinator

Republic of the Philippines

Republic of the Philippines

Republic of the Philippines

ASSUMED COST OF ITEMS

Committee on Documentation Chair/Member

Republic of the Philippines

Program Implementation Committee Chair/Member

Date Prepared: ____________

Republic of the Philippines

Republic of the Philippines

Republic of the Philippines

Republic of the Philippines

Republic of the Philippines

D. ESTIMATED COST OF VOLUNTEER SERVICES RENDERED

Total Number of Hours

Total Estimated Costs

E. SIGNIFICANT EVENTS / EXPERIENCES

Who were involved?

What is/are important

Republic of the Philippines

G. SUGGESTIONS TO STRENGTHEN BRIGADA ESKWELA PROJECT

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