Brigada Eskwela Blank Forms

BE Form 01
Republic of the Philippines

Department of Education
Region I
SCHOOLS DIVISION OFFICE I PANGASINAN
Lingayen
PARAYAO NATIONAL HIGH SCHOOL
Binmaley
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 Nature of
Remarks Manpower
(Check One) improvement
Material Resources Needed(Indicate
Needed
FACILITIES If Unsatisfactory, Needed (Indicate quantity and nature of
(e.g. repair,
Satisfactory Unsatisfactory describe the kind and quality) labor services
repainting,
problem needed)
replacement, etc)
 Roofs/Gutters 
 Ceilings  Faded & dirty Needs repainting Plywood, paint & Carpenter/painter
brush
 Walls  Dirty Needs repainting Paint and brush painter
 Blackboards 
 Chairs/desks/tables  Destroyed & Needs repair Nails, wood, brush carpenter
defective and paint
 Water facilities/  Defective faucets Needs replacement faucets plumber
Drainage System
 Signages  Faded Needs replacement Paint and brush Painter
 School garden  Tall grasses Needs cutting Worker and laborer laborer
 Lighting  Defective switches Needs repair Electrical wire, bulb electrician
and switches
 Windows  Lack and defective Needs repair Wood, nails, and carpenter
jalousies jalousies
 Doors  Needs replacement Needs repair Plywood, nails, paint carpenter
and brushes
 Comfort Rooms  Lack of lightings Needs light Electrical wire/bulbs electrician
 School Grounds  Tall grasses and Needs cutting Machine grass cutter laborer
tress and gasoline
 School Canteen/Clinic  Needs improvement Plywood, nails, paint carpenter
and brush
 School Fence/ wall  Partially destroyed Needs improvement Cement and mason
hollowblocks
 Electricity  Partially destroyed Needs repair Electrical wires electrician
 Alternative gate  Cement and mason
hollowblocks
 Reference Materials  Partially destroyed Lack of reference
 Laboratory equipment  Partially destroyed Lack of reference

and equipment
Prepared by: Noted:
_______________________________ _________________ ____________________________________
School Physical Facilities Coordinator Date of Inspection School Head

BE Form 02

Region I
SCHOOLS DIVISION OF ILOCOS SUR
(Name of School)
(School Address)
School Year _________
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 Person’s Responsible Materials Needed Budget

- Conference with the May 23 - 27, 2016 Tarpaulin, blackboard
teachers/officers of the faculty club Colored chalk
for the activity Coupon bonds 300
- posting tarpaulin in front of the May 27, 2016 Cellphone/load
Teachers
school reminding and inviting
1.Advocacy and PTA Secretary
everybody to join.
Marketing School Secretary
- tap neighbors to join the activity Vehicles, Sound
School Guard
- caravan along the catchment areas May 30, 2016 system 500
of PNHS
TOTAL ____________
P 800.00
Assigning work of Brgy. Officials, May 30, 2016  PTA Secretary  Electrical Materials 2000.00
Parents, students, PTA officers and  School Secretary  Plumbing materials -
others  School Guard  Garden tools -
2.Resource  Cleaning materials 500.00
Mobilization
___________
TOTAL P2,500.00
- volunteers register in the log book May 30 – June 4 2016  Head Teachers  Electrical Materials -
3. Implementation - match volunteers and materials -
 PTA and  Plumbing materials
against the identified needs community  Garden tools -
- organized and orient the working representative in  Cleaning materials -
teams according to nature of service the different  Gasoline 200.00
to be done baragays
 others TOTAL 200.00
Working teams are as follows:
 Ordinary labor May 30 – June 4 2016  V-Pres (PTA) Coupon bond 320.00
 Painting May 30 – June 4 2016  PTA Ball pen 10.00
4. Monitoring and  Plumbing May 30 – June 4 2016 Representative Camera 500.00
Evaluation  Electrical May 30 – June 4 2016  School Teachers Photo paper 360.00
 Mason May 30 – June 4 2016
 Photo documentation May 30 – June 4 2016 TOTAL 1,190.00
 Presenting of June 4, 2016 Head Teachers Certificates

accomplishments by Principal Camera
working teams Photo paper
5. Reporting  Sharing experiences Printer
 Asking partners to pledge
continuing support
 Expressing appreciation
Prepared by: Noted by:
___________________________________ _________________________ _____________________________
Signature over Printed name Date Prepared ASP Division Coordinator/ BE coordinator
BE Form 03

Region I
(Name of School)
(School Address)
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.
Key
Strategies/Plan of
Materials Needed Quantity Persons/Organization to Person Responsible Status Remarks
Action
be Tapped
Plywood 1/4 3 PTA, People Voluntary Member Purchased enough
Nails 2 kls PTA, People Contributions Purchased enough
Paint 40 liters PTA, People Purchased enough
Cement 3 bags PTA, People Purchased enough
Fluorescent bulb 3 pcs PTA, People Purchased enough
CFL bulbs 5 pcs PTA, People Purchased enough
Faucets 10 pcs PTA, People Purchased enough
Teflon 2 pcs PTA, People Purchased enough
Switches 8 pcs PTA, People Purchased enough
plug 10 pcs PTA, People Purchased enough

Labor Key
Strategies/Plan of
Skills/Volunteers Quantity Persons/Organization to Person Responsible Status Remarks
Action
Needed be Tapped
Carpentry
Plumbing
Electrical
Trimming of tall
trees/grasses
Ordinary labor
cleaning
mason
Prepared by: Noted:
___________________________________________ _______________________________________________
Resource Mobilization Committee Chairperson School Head

BE Form 04

Region I
(Name of School)
(School Address)
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.
TOTAL “NATURE OF
NAME POSITION/ ADDRESS/ CONTACT TIME SIGNATURE NUMBERS VOLUNTEER
DESIGNATION ORGANIZATION/ NUMBER OF SERVICES
AFFILIATION IN OUT HOURS RENDERED
SERVED
Noted:
___________________________________________ _________________________________
School Head Date
BE Form 05

Region I
(Name of School)
(School Address)
BRIGADA ESKWELA
RECORD OF DONATIONS RECEIVED
ITEMS/ MATERIALS QUANTITY DATE RECIEVED NAME OF DONOR ASSUMED COST OF ITEMS
Per Unit Total
TOTAL
________________________________________________ ______________________________________________
Committee on Documentation Chair/Member School Head
BE Form 06

Region I
(Name of School)
(School Address)
BRIGADA ESKWELA
DAILY ACCOMPLISHMENT REPORT
DAY 1 2 3 4 5 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.
STATUS
Started but not yet REMARKS/RECOMMENDATIONS
Activities Completed Not done
completed
Day 1
Day 2
Day 3
Day 4
Day 5
Day 6
________________________________________________ ______________________________________________
Program Implementation Committee Chair/Member School Head
Date Prepared: ____________
BE Form 7

Region I
(Name of School)
(School Address)
BRIGADA ESKWELA
SCHOOL ACCOMPLISHMENT REPORT
DIVISION: Ilocos Sur REGION: I

SCHOOL: SCHOOL ID:
SCHOOL ADDRESS:
(Please check appropriate box)
Level: Type of School:

Elementary Central School
 High School Non- Central School (Complete)
Multi-grade
Primary School (Complete)
Integrated
SCHOOL HEAD: CONTACT NO.:

PTA PRESIDENT: CONTACT NO.:
BE Form 07

Region I
(Name of School)
(School Address)
A. SCOPE OR REPAIR AND MAINTENANCE WORK COMPLETED (Please check appropriate column)
What was done?
Others
Repaired Repainted Replaced
(Brief Description)
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
BE Form 07

Region I
(Name of School)
(School Address)
B. DONATIONS/MATERIALS RESOURCES GENERATED (Use separate sheets, if needed)

Type of Donations Sources Estimated Cost
TOTAL
BE Form 07

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

Region I
(Name of School)
(School Address)
D. ESTIMATED COST OF VOLUNTEER SERVICES RENDERED

Type of Service Total Number of Volunteers Total Number of Hours Rendered Total Estimated Costs
Carpentry
Masonry
Gardening/ Landscaping
Painting
Welding
Electrical/ Electronics
Plumbing
Ordinary Labor
TOTAL
BE Form 07

Region I
(Name of School)
(School Address)
E. SIGNIFICANT EVENTS / EXPERIENCES

What is/are important contribution
What happened? Who were involved? When? to the operation to the school or to
existing needs of the school?

BE Form 07

Region I
(Name of School)
(School Address)
F. LESSONS LEARNED
G. SUGGESTIONS TO STRENGTHEN BRIGADA ESKWELA PROJECT
Prepared by: Date:
_____________________________
_________________________________________
School Head

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BE Form 01

Republic of the Philippines

 Laboratory equipment  Partially destroyed Lack of reference

Prepared by: Noted:

_______________________________ _________________ ____________________________________

School Physical Facilities Coordinator Date of Inspection School Head

Republic of the Philippines

KRA Activities Timeline Person’s Responsible Materials Needed Budget

 Presenting of June 4, 2016 Head Teachers Certificates

Prepared by: Noted by:

___________________________________ _________________________ _____________________________

Republic of the Philippines

Paint 40 liters PTA, People Purchased enough

Cement 3 bags PTA, People Purchased enough

Fluorescent bulb 3 pcs PTA, People Purchased enough

CFL bulbs 5 pcs PTA, People Purchased enough

Faucets 10 pcs PTA, People Purchased enough

Teflon 2 pcs PTA, People Purchased enough

Switches 8 pcs PTA, People Purchased enough

plug 10 pcs PTA, People Purchased enough

Prepared by: Noted:

Resource Mobilization Committee Chairperson School Head

Republic of the Philippines

School Head Date

Republic of the Philippines

Committee on Documentation Chair/Member School Head

Republic of the Philippines

DAY 1 2 3 4 5 6 DATE: _________________

Prepared by: Noted by:

Date Prepared: ____________

Republic of the Philippines

DIVISION: Ilocos Sur REGION: I

Level: Type of School:

SCHOOL HEAD: CONTACT NO.:

Republic of the Philippines

Republic of the Philippines

B. DONATIONS/MATERIALS RESOURCES GENERATED (Use separate sheets, if needed)

Republic of the Philippines

Republic of the Philippines

D. ESTIMATED COST OF VOLUNTEER SERVICES RENDERED

Republic of the Philippines

E. SIGNIFICANT EVENTS / EXPERIENCES

Republic of the Philippines

G. SUGGESTIONS TO STRENGTHEN BRIGADA ESKWELA PROJECT

Prepared by: Date:

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_______________________ _ ____________________________

_______________________ _ _________________