Appendix B

BE Form 01
Republic of the Philippines
Department of Education
Region:
Division:
District (for Elementary):
School:
School Year 2011-2012

2011-2012 BRIGADA ESKWELA

PHYSICAL FACILITIES REPAIR AND MAINTENANCE NEEDS ASSESSMENT FORM
(To be accomplished by the School Physical Facilities Coordinator)
Instruction: Conduct an ocular inspection of the school physical facilities 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.)

FACILITIES Condition Remarks Nature of Improvement Material Resources Manpower Needed

(Check One) Needed Needed (Indicate quantity
Satisfactory Unsatisfactory If Unsatisfactory, (e.g. repair, repainting, (Indicate kind and and nature of labor
describe the problem. replacement, etc.) quantity) services needed)
 Roofs/gutters
 Ceilings
 Walls
 Blackboards
 Chairs/desks/tables
 Water facilities/
Drainage System
 Signages
 School garden
 Lighting
 Windows
 Doors
 Comfort rooms
 School grounds
 School canteen/clinic
 School fence
 Others, please specify:

Prepared by: Noted:

________________________________ _________________________ ________________________________
School Physical Facilities Coordinator Date of Inspection TIC/Head Teacher/Principal
*send e-copy to dpdpessd@yahoo.com
*File Name for Elementary Schools: District-School- BE Form 01
*File Name for Secondary Schools: School- BE Form 01