8/13/2019 BE Form 01
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Appendix B
BE Form 01Republic of the PhilippinesDepartment of
EducationRegion:02Division:IsabelaDistrict for Elementar!":#anto
$omas#chool: B%&'$%RI E(E)E$%R* #+,--(##chool *ear
2011.2012
2011.2012 BRI&%D% E#/E(%PHYSICAL FACILITIES REPAIR AND
MAINTENANCE NEEDS ASSESSMENT FORM
$o be accomplished b! the #chool Ph!sical Facilities
+oordinator"Instruction: +onduct an ocular inspection of the school
ph!sical facilities listed belo $hen provide the needed information
to facilitate the improvement tobe done on these identified
facilities If needed3 !ou ma! use separate forms for each classroom
or school facilit!"
FACILITIES Condition(Check One
Re!"rks N"ture o# I!$ro%e!entNeeded
(e&'& re$"ir re$"intin're$)"ce!ent etc&
M"teri") ResourcesNeeded
(Indic"te kind "nd*u"ntit+
M"n$o,er Needed(Indic"te *u"ntit+
"nd n"ture o# )"-orser%ices needed
Satisfactory Unsatisfactory I# .ns"tis#"ctor+descri-e the
$ro-)e!&
Roofs4gutters5
lea6ing Repair4replacement 70pcs &I
sheet386gs&Inail3I(vulcaseal
9 carpenters
+eilings 5 o ceiling3 Installation of ceiling3painting 100pcs
pl!ood3 7000bdft lumber 2 painters47carpenters
alls 5 Faded4dull4dilapidating Repainting4replacement 7 pails
paintlate5tinting color4 paint brush
; rollers418 bagscement4220 hollobloc6s418pcs 12mm
rods 1 load gravel andsand
2 painters42carpenters
Blac6boards 5 orn out replacement 10 piecesblac6board326gs
concrete nail
2 carpenters
+hairs4des6s4tables 5 Procurement4repair 70pcs arm
chair326gs
nail
1 carpenter
ater facilities4
Drainage #!stem
5 o ater s!stem Installation a #et of pump ell 7 plumbers
#ignages 5 o signages Put up signages 1 pc flat iron sheet31
galpaint
1 carpenter41 painter
#chool garden 5 o nurser!4unplanted Installation4planting 2
rolls barbed ire47rolls hog ire
2 ordinar! laborers
(ighting 5 Dull lamps4lac6ing Replacement of bulbs
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sealant31pc silicon guns
Doors 5 Destro!ed door and=amb
Repair4replacement 200bf (umber376gs cnassorted"
1 carpenter
+omfort rooms 5 Destro!ed septic tan6sand bols4installation
in
8 rooms
Repair4installation 2 loads gravel andsand30pcs10mm ; 90pcs
?mmrods3 8 toilet bols3
cement 18 bags
7 carpenters
#chool grounds 5 Easil! flooded portionof the school
bac6fill 10 loads gravel 8 ordinar! laborers
#chool canteen4clinic
#chool fence 5 Incomplete concretefence4unfinished and
unpainted
Installation4finishing4painting
2 pails @DE paint and1gal paint thinner
2000,B3280 10mmrods3 7loads gravel andsand3180 bags cement
9 carpenters42painters
-thers3 please specif!:
1 B(#Bto.room"buildingneeds general repair
Prepared b!: oted:
AAAAAPRE#+I((% + P%DREAAAAAAA AA)a! 2932011
AAAAA AAAAAAA#*(I% & B'+%&AAAAA#chool Ph!sical
Facilities +oordinator Date of Inspection ,ead $eacher 7Csend
e.cop! to dpdpessd!ahoocomCFile ame for Elementar! #chools:
District.#chool. BE Form 01CFile ame for #econdar! #chools: #chool.
BE Form 01
mailto:[email protected]:[email protected]
