Appendix B

BE Form 01
Republic of the Philippines
Department of Education
Region:
Division:
District (for Elementary:
!chool:
!chool "ear #011$#01#
#011$#01# BR%&'D' E!()E*'
PHYSICAL FACILITIES REPAIR AND MAINTENANCE NEEDS ASSESSMENT FORM
(+o be accomplished by the !chool Physical Facilities ,oordinator
Instruction: ,onduct an ocular inspection of the school physical facilities listed belo-. +hen provide the needed information to facilitate the improvement to be done on these
identified facilities. (%f needed/ you may use separate forms for each classroom or school facility.
FACILITIES Condition
(Check One
Re!"rks N"ture o# I!$ro%e!ent
Needed (e&'&
re$"ir( re$"intin'(
re$)"ce!ent( etc&
M"teri") Resources
Needed
(Indic"te kind "nd
*u"ntit+
M"n$o,er Needed
(Indic"te *u"ntit+ "nd
n"ture o# )"-or
ser%ices needed
Satisfactory Unsatisfactory I# .ns"tis#"ctor+(
descri-e the $ro-)e!&
Roofs0gutters 0
,eilings 0
)alls 0
Blac1boards 0
,hairs0des1s0tables 0
)ater facilities0 Drainage
!ystem
0 2o -ater facilities02o
proper drainage
!ignages 0
!chool garden 0 s-ampy Bac1 filling &arden soil$3 loads 3 laborers
*ighting 0 4ld electric -ires Electrical Re-iring 1 electrician and 1
laborer
)indo-s 0
Doors 0
,omfort rooms 0
!chool grounds 0
!chool canteen0clinic 0 2o e5isting rooms for
canteen and clinic
!chool fence 0 !outh perimeter needs
concrete fence
,onstruction of the fence 1000pcs. hallo- bloc1s
#00bags cement
#00pcs.iron bars
6 marine ply
# s1illed -or1ers
6 laborers
6 mason
4thers/ please specify:
Prepared by: 2oted:
77777777777777777777777777777777 7777777777777777777777777 77777777777777777777777777777777
!chool Physical Facilities ,oordinator Date of %nspection +%,08ead +eacher0Principal
9send e$copy to dpdpessd:yahoo.com
9File 2ame for Elementary !chools: District$!chool$ BE Form 01
9File 2ame for !econdary !chools: !chool$ BE Form 01