Republic of the Philippines

POLYTECHNIC COLLEGE OF BOTOLAN

(Formerly Botolan Community College)
Botolan Zambales
E-mail: polytechniccollegeofbotolan@gmail.com
Website: www.pcb2009.net

PHYSICAL FACILITIES AND MAINTENANCE NEEDS ASSESSMENT FORM

CICT Department
Room 102
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).
Nature of improvement Material Resources Needed Manpower Needed
CONDITION (Check One) Remarks
Needed (Indicate kind and quality) (Indicate quantity and
FACILITIES
Satis- Unsatis- (e.g. repair, repainting, nature of labor services
None If Unsatisfactory, describe the problem Kind/Item Quantity Unit
factory factory replacement, etc.) needed)
 Roofs/Gutters 
 Ceilings 
 Walls 
 Lighting  One of the switch has no cover Needs cover 1 1
 Electrical Outlets 
Some of the windows are broken and no handle. Repair, replace and
 Windows  13 1
The windows are too tight to open and close. greased
 Doors 
 Door knobs 
 Comfort Room 
 Water facilities  The water from the tank is dirty. Needs inspection 1
 Blackboards 
 Bulletin boards (2 per room) 
 Arm Chairs 
 Trashcans (3)  Lack of trashcan to fit a large amount of trash. Additional large trashcans 2
Needs to provide
 Teacher’s Table  1
Teacher’s Table
Needs to provide
 Teacher’s Chair  1
Teacher’s Chair
Needs to provide
 Supervisory Table  1
Supervisory Table
The plants get easily withered on the area More plants and some
 School garden/ground assignment  20 2
because of the soil. landscaping
 Others, pls. specify

Prepared by: Noted: Date of Inspection:

Edelwise S. Ignacio Mary Jane A. Dizon April 15, 2019
Program Coordinator