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Republic of the Philippines

DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT


DILG-NAPOLCOM Center, EDSA cor. Quezon Ave., Quezon City
Telephone Number (02) 925-1137

BADAC FUNCTIONALITY SELF-ASSESSMENT AND AUDIT FORM


for the year 20019

Region: IV-A Calabarzon City/Municipality: San Nicolas


Province: Batangas Barangay: Talang Contact # 9.6E+09

Instruction: Put a check ✓ on the box that corresponds to the given questions. FOR C/MLGOO / CD USE ONLY

INDICATORS YES NO MEANS OF VERIFICATION POINTS REMARKS

1. Is BADAC composed of at least seven (7) members? Executive Order (Required)


BADAC Organizational Structure
Copies of IDs issued to BADAC members
Appointment papers
Others, please specify: ______________________

2. Did the BADAC organize a Committee on Operations? Executive Order (Required)


BADAC Organizational Structure
Copies of IDs issued to BADAC members
Appointment papers
Others, please specify: ______________________

3. Did the BADAC organize a Committee on Advocacy? Executive Order (Required)


BADAC Organizational Structure
Copies of IDs issued to BADAC members
Appointment papers
Others, please specify: ______________________

4. Did the BADAC organize a BADAC Auxiliary Team? Executive Order w/ attached list of updated
BAT members (Required)
BADAC Organizational Structure
Copies of IDs issued to BAT members
Appointment papers
Others, please specify: ______________________

IN COMPLIANCE WITH DILG-DDB JOINT MEMORANDUM CIRCULAR NO. 2018-01 BADAC FUNCTIONALITY SELF-ASSESSMENT AND AUDIT FORM
FOR C/MLGOO / CD USE ONLY

INDICATORS YES NO MEANS OF VERIFICATION POINTS REMARKS

5. Did the BADAC organize House Clusters? Executive Order (Required)


BADAC Organizational Structure
Copies of IDs issued to House Cluster Leaders
Appointment papers
Others, please specify: ______________________

6. Did the BADAC designate Barangay Duty Officers (BDO)? Executive Order (Required)
BADAC Organizational Structure
Copies of IDs issued to Barangay Duty Officers
Appointment papers
Others, please specify: ______________________

7. Is there a desk or space in the barangay designated Actual photo of the desk (Required)
as Referral/BADAC Desk? Others, please specify: ______________________

8. Did the Punong Barangay attend training on Copy of Certificate of Participation (Required)
Strengthening BADACs, or other relevant trainings? Copy of attendance sheet w/ the title of the
activity, date/time, and venue
Attestation from the lead organizer
Others, please specify: ______________________

INDICATORS YES NO N/A MEANS OF VERIFICATION

9. Did the Punong Barangay attend any training or planning Copy of Cert. of Participation (Required)
session on Community Support, Aftercare, and Reintegration Copy of attendance sheet w/ the title of the
Program (CSAR)? activity, date/time, and venue
Attestation from the lead organizer
Others, please specify: _______________
In case the CADAC/MADACs were not able to organize any
consultation or planning workshop on reintegration program, the
BADACs should check the corresponding box for “N/A” in page 2,
item number nine (9) of BADAC Self-Assessment and Audit Form.
With respect to this, the C/M LGOO or CD shall allocate the
corresponding one (1) point

IN COMPLIANCE WITH DILG-DDB JOINT MEMORANDUM CIRCULAR NO. 2018-01 BADAC FUNCTIONALITY SELF-ASSESSMENT AND AUDIT FORM
FOR C/MLGOO / CD USE ONLY

INDICATORS YES NO MEANS OF VERIFICATION POINTS REMARKS

10. Did the BADAC conduct at least one (1) training for the BADAC Activity Report with attendance sheets (Required)
BADAC House Cluster Leaders? Photo/video documentation
Copies of evaluation or feedback forms
Copy of signed liquidation report
Copy of Certificate of Participation awarded to
cluster leaders
Others, please specify: ______________________

11. Did the BADAC conduct at least one (1) training for the BADAC Activity Report with attendance sheets (Required)
BADAC Auxiliary Team (BAT)? Photo/video documentation
Copies of evaluation or feedback forms
Copy of signed liquidation report
Copy of Certificate of Participation awarded to BAT
members
Others, please specify: ______________________

12. Did the Barangay Duty Officers attend at least one (1) Copies of Certificate of Participation (Required)
training on Community-Based Rehabilitation Program or Copy of attendance sheet with title of the activity,
other relevant trainings? date/time, and venue
Photo documentation
Attestation from lead organizer
Others, please specify: ______________________

13. Did the BADAC conduct at least one (1) consultative BADAC Activity Report with attendance sheets (Required)
meeting with stakeholders? Photo/video documentation
Minutes of the meeting/proceedings
Others, please specify: ______________________

14. Did the BADAC conduct regular monthly meetings? Copies of BADAC monthly meeting minutes with
Number of months in which meetings were conducted attendance sheets (Required)
10-12 months Photo/video documentation
8-9 Minutes of the meeting/proceedings
6-7 Others, please specify: ______________________
4-5
1-3
0

IN COMPLIANCE WITH DILG-DDB JOINT MEMORANDUM CIRCULAR NO. 2018-01 BADAC FUNCTIONALITY SELF-ASSESSMENT AND AUDIT FORM
FOR C/MLGOO / CD USE ONLY

INDICATORS YES NO MEANS OF VERIFICATION POINTS REMARKS

15. Did the BADAC organize / co-organize at least two (2) BADAC Activity Report (Required)
community-based IEC campaign activities? Attendance sheets
Photo/video documentation
Copies of evaluation or feedback forms
Copy of signed liquidation report
Copy of IEC materials used
Others, please specify: _______________________

16. Did the BADAC organize / co-organize at least one (1) BADAC Activity Report (Required)
school-based IEC campaign activity? Attendance sheets
Photo/video documentation
Copies of evaluation or feedback forms
Copy of signed liquidation report
Copy of IEC materials used
Others, please specify: _______________________

17. Did the SK or any youth organizations in the barangay Activity report by the youth organization (Required)
conduct at least one (1) drug awareness Attendance sheets
campaign activity? Photo/video documentation
Copies of evaluation or feedback forms
Copy of signed liquidation report
Copy of IEC materials used
Others, please specify: _______________________

18. Did any Civil Society Organizations (CSOs) conduct Activity report by the CSO (Required)
at least one (1) drug awareness campaign activity in Attendance sheets
the barangay? Photo/video documentation
Copies of evaluation or feedback forms
Copy of signed liquidation report
Copy of IEC materials used
Others, please specify: ______________________

19. Did the BADAC organize / co-organize any activities BADAC Activity Report (Required)
in observance of the International Day Against Drug Attendance sheets
Abuse and Illicit Trafficking (IDADAIT)? Photo/video documentation
Copies of evaluation or feedback forms
Copy of signed liquidation report
Copy of IEC materials used

IN COMPLIANCE WITH DILG-DDB JOINT MEMORANDUM CIRCULAR NO. 2018-01 BADAC FUNCTIONALITY SELF-ASSESSMENT AND AUDIT FORM
Others, please specify: ______________________

FOR C/MLGOO / CD USE ONLY

INDICATORS YES NO MEANS OF VERIFICATION POINTS REMARKS

20. Did the BADAC organize / co-organize any activities in BADAC Activity Report (Required)
observance of the Drug Abuse Prevention and Control Attendance sheets
Week (DAPC)? Photo/video documentation
Copies of evaluation or feedback forms
Copy of signed liquidation report
Copy of IEC materials used
Others, please specify: ______________________

21. Did the BADAC submit an updated number of residents Copy of the Barangay Duty Officer's logbook, or
who surrendered through the Barangay Duty Officers and copy of the logbook/reports from mandated agencies
other mandated agencies? where the resident surrendered (Required)
Others, please specify: ______________________

22. Did the BADAC submit an updated number of residents Copy of referral letter from the barangay, received by
who were referred to higher ADACs and other law CADAC/MADAC, or other law enforcement
enforcement agencies for assessment? agencies (Required)
BDO's logbook showing the referral date
Others, please specify: _______________________

23. Did the BADAC submit an updated number and status of List of updated number and status of residents
residents who were assessed and enrolled in any enrolled in Wellness and Recovery Interventions
Wellness and Recovery Interventions? issued by CADAC/MADAC (Required)
Copies of Individual Treatment Card/Book
Others, please specify: _______________________

24. Did the BADAC submit an updated number of residents List of updated number of residents who completed
who have completed prescribed Wellness and Recovery their prescribed Wellness and Recovery Interventions
Inteventions? issued by CADAC/MADAC (Required)
Copies of Certificate of Completion
Copies of clearance certificate issued by authorized
service provider
Others, please specify: _______________________

25. Did the BADAC submit an updated number of residents List of updated number of residents enrolled in CSAR
enrolled in CSAR or any equivalent reintegration program? program, or its equivalent, issued by
CADAC/MADAC (Required)

IN COMPLIANCE WITH DILG-DDB JOINT MEMORANDUM CIRCULAR NO. 2018-01 BADAC FUNCTIONALITY SELF-ASSESSMENT AND AUDIT FORM
Copies of Individual Treatment Card/Book
Others, please specify: _______________________

FOR C/MLGOO / CD USE ONLY

INDICATORS YES NO MEANS OF VERIFICATION POINTS REMARKS

26. Did the BADAC submit an updated number of residents List of updated number of residents who completed
who completed the CSAR or any equivalent reintegration the CSAR Program issued by CADAC/MADAC (Required)
program? Copies of Certificate of Completion, or copy of
Clearance Certificate issued by authorized service
provider
Others, please specify: _______________________

27. Did the BADAC submit the Summary of Consolidated Certificate of submission from CADAC/MADAC and
Information Report (CIR)? local PNP unit (Required)
Copy of received transmittal form
Others, please specify: _______________________

28. Did the BADAC submit an updated CIR to CADAC/MADAC Certificate of submission from CADAC/MADAC and
and local PNP unit? local PNP unit (Required)
Copy of received transmittal form
Others, please specify: _______________________

29. Did the BADAC submit its Barangay CSAR or any Copy of approved Barangay CSAR Plan, or equivalent,
equivalent reintegration plan as incorporated in their BADPA? received by CADAC/MADAC (Required)
Others, please specify: _______________________

30. Did the BADAC prepare its own BADAC Plan of Action Copy of approved BADPA or copy of approved
(BADPA) for FY 2017? BPOPS Plan with BADPA (Required)
Others, please specify: _______________________

31. Did the BADAC appropriate a substantial budget for its Copy of approved Barangay Annual Budget w/
anti-illegal drug activities for FY 2017? budget allocation for BADAC (Required)
Others, please specify: _______________________

Total annual budget: _______________________


Allocation for BADAC: _______________________

32. Did the BADAC submit its Annual BADAC Accomplishment Copy of Annual BADAC Accomplishment and Fund
and Fund Utilization Report to CADAC/MADAC and other Utilization Report (Required)
agencies? Others, please specify: _______________________

Audited by:

IN COMPLIANCE WITH DILG-DDB JOINT MEMORANDUM CIRCULAR NO. 2018-01 BADAC FUNCTIONALITY SELF-ASSESSMENT AND AUDIT FORM
DIOSDADO M. LA ROSA TOTAL POINTS
Signature over Printed Name of City/Municipal LGOO or City Director
Date signed: ________________ LEVEL OF FUNCTIONALITY

IN COMPLIANCE WITH DILG-DDB JOINT MEMORANDUM CIRCULAR NO. 2018-01 BADAC FUNCTIONALITY SELF-ASSESSMENT AND AUDIT FORM
Republic of the Philippines
DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT
DILG-NAPOLCOM Center, EDSA cor. Quezon Ave., Quezon City
Telephone Number (02) 925-1137

BADAC FUNCTIONALITY SELF-ASSESSMENT AND AUDIT FORM

CERTIFICATION OF TRUTH, ACCURACY, AND COMPLETENESS


The undersigned certify under penalty of law, based on information and belief formed after reasonable inquiry, the
statements and information contained in this document are true, accurate, and complete.

Hon. ARNOLD A. ENCARNACION Hon. BONIFACIO A. ENERO JR.


Signature over Printed Name of Chair of Committee on Advocacy Signature over Printed Name of Chair of Committee on Operations
Date signed: _________________ Date signed: _________________

Hon. RHANDI M. A ENAS


Signature over Printed Name of Punong Barangay / BADAC Chairperson
Date signed: _________________

Noted by:

Eng. DIOSDADO M. LA ROSA Hon. LESTER D. DE SAGUN


Signature over Printed Name of City/Municipal LGOO or City Director Signature over Printed Name of City/Municipal Mayor
Date signed: ________________ Date signed: _______________

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