BE Form 01

Republic of the Philippines

Department of Education
Region IV- A CALABARZON
SCHOOLS DIVISION OF LIPA CITY
TEODORO M. KALAW MEMORIAL
Balintawak, Lipa City
2017-2018

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 Nature of
Remarks improvement Manpower
(Check One) Material
Needed Needed(Indicate
If Resources
FACILITIES (e.g. repair, quantity and
Satisfacto Unsatisfact Unsatisfactory, Needed (Indicate
repainting, nature of labor
ry ory describe the kind and quality)
replacement, services needed)
problem etc)
Roofs/Gutters / Need to be repaint paint painter
repainted
Ceilings / repair
Walls /
Blackboards /
Chairs/desks/tables / Need to be Repainting/repair paint painter
repainted/repaired
Water facilities/ / Need to be repair Tube, pipe laborer
Drainage System repaired/faucet
Signages /
School garden / Need to be pruned gardening Garden tools laborer
Lighting /
Windows / Need to be repair tools laborer
repaired
 Doors /
Comfort Rooms / Need to be repair tools laborer
repaired
School Grounds /
School Canteen/Clinic /
School Fence/ wall /
Electricity / Need to install
proper wiring
Alternative gate /
Reference Materials /
Laboratory equipment /

Prepared by: Noted:

LAARNI E. LIBUIT May 20, 2017 EDITH F. ABDON

School Physical Facilities Coordinator Date of Inspection Officer-In-Charge