BE Form 01

Republic of the Philippines

Department of Education
Region VI
SCHOOLS DIVISION OF NEGROS OCCIDENTAL
EFIGENIO-ENRICA LIZARES MEMORIAL SCHOOL
MABINI STREET TALISAY CITY
School Year 2019-2020

BRIGADA ESKWELA 2019

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
Remarks Nature of Manpower
(Check One) Material Resources
improvement Needed Needed(Indicate
FACILITIES If Unsatisfactory, Needed (Indicate kind
(e.g. repair, repainting, quantity and nature of
Satisfactory Unsatisfactory describe the and quality)
replacement, etc) labor services needed)
problem
 Roofs/Gutters
 Ceilings Needs repair replacement
 Walls
 Blackboards
 Chairs/desks/tables Needs repair Needs repair Prepared by:
 Water facilities/ Needs repair Needs repair
Drainage System
 Signages
 School garden
 Lighting
 Windows
 Doors Needs repair Needs replacement
 Comfort Rooms Needs repair Needs repair
 School Grounds
 School Canteen/Clinic
 School Fence/ wall
 Electricity Noted:
 Alternative gate
 Reference Materials
 Laboratory equipment No laboratory

_______________________________ _________________ ___________________________________

School Physical Facilities Coordinator Date of Inspection School Head