Form 2.

1
Department of the Interior and Local Government Financial Administration
CY 2022 Seal of Good Local Governance

Seal of Good Local Governance – DOCUMENTARY CHECKLIST

Form 2.1 Financial Administration

City/Municipality of : __________________________________ Income Class : _____________

Province : __________________________________ Region : _____________

INSTRUCTIONS: PLEASE READ BEFORE PROCEEDING TO THE ITEMS. Assigned DILG Field Officer: (1) This is the list
of documents which shall serve as basis in the provision of data for the RAT’s table assessment. (2)Tick the box before each
document to indicate availability. (3) For each available document other than the Certified Forms and photos, highlight the
portion, word or phrase that supports the data being required.

Data Available Documents

1. Audit opinion and recommendations acted upon ☐ LGU’s CY 2020 Annual Audit Report by the
Commission on Audit
☐ LGU’s CY 2021 Annual Audit Report by the
Commission on Audit
2. Compliance with the Full Disclosure Policy for CY 2021 2nd ☐ Form 2E: Photo Documentation
to 4th quarters and CY 2022 1st quarter, posting in 3
conspicuous places and FDP portal
3. Local revenue growth for the 3 consecutive ☐ Certified Form 2K (Treasurer’s Office)
Ye years (2018 to 2020) ☐ Data from SREs prepared by the Treasurer for CYs
2018 to 2020
4. Utilization of 20% component of the CY 2020 Internal ☐ Certified Form 2K (Treasurer’s Office)
Revenue Allotment ☐ Data from SREs prepared by Local Treasurer for CY
2020
5. Utilization of Performance Challenge Fund, if applicable ☐ Certified Form 2A (Accounting Office)
☐ Data on PCF status of funds prepared by Local
Accountant for funds received in CY 2019 and earlier
6. Utilization rate of funding assistance from Assistance to ☐ Certified Form 2A (Accounting Office)
Municipalities program (formerly Bottom-Up Budgeting), if ☐ Data on BuB-AM status of funds by Local Accountant
applicable for funds received in CYs 2017 to 2020
7. Approved CY 2022 annual budget ☐ Ordinance enacting the LGU’s CY 2022 annual budget

Other Supporting Documents (to be supplied only if the listed documents are NOT yet available)

Data Available Documents

1
 Department of the Interior and Local Government
CY 2022 Seal of Good Local Governance

Prepared by: Certifying completeness of documentary

submission:

(Name and Signature) (Name and Signature)

DILG Field Officer DILG Cluster Head/LGPMS-RFP

Date signed: _____________________________ Date signed: ______________________________

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 Form 2.2
Department of the Interior and Local Government Disaster Preparedness
CY 2022 Seal of Good Local Governance

Seal of Good Local Governance – DOCUMENTARY CHECKLIST

Form 2.2 Disaster Preparedness

City/Municipality of : __________________________________ Income Class : _____________

Province : __________________________________ Region : _____________

INSTRUCTIONS: PLEASE READ BEFORE PROCEEDING TO THE ITEMS. Assigned DILG Field Officer: (1) This is the list
of documents which shall serve as basis in the provision of data for the RAT’s table assessment. (2)Tick the box before each
document to indicate availability. (3) For each available document other than the Certified Forms and photos, highlight the
portion, word or phrase that supports the data being required.

Data Available Documents

1. Functionality of LDRRMC
1.a. Composition ☐ Executive Order, Ordinance, or similar issuance creating
the LDRRMC
☐ Certificates of Accreditation or Certification of Selection
1.b. Meetings ☐ LDRRMC Notice of Meetings, Agenda, and Minutes of the
Meetings for CY 2021
2. Functionality of LDRRMO
2a. Plantilla LDRRM Officer (Head of office) ☐ Appointment of LDRRM Officer –Head of Office with CSC
attestation
☐ CSC Resolution granting the LGU authority to take final
action on its appointment, in case the LGU is accredited
☐ Letter for CSC Field Office transmitting copy, and
requesting attestation of appointment, in case LGU is not
accredited
2b. Plantilla LDRRMO Staff ☐ Appointment of LDRRMO staff with CSC attestation
☐ CSC Resolution granting the LGU authority to take final
action on its appointment, in case the LGU is accredited
☐ Letter for CSC Field Office transmitting copy, and
requesting attestation of appointment, in case LGU is not
accredited
☐ Executive order/ similar issuance for designation of
LDRRMO staff
3b. LDRRMO Workspace ☐ Form 2E: Photo Documentation

3. Approved PDPFP or CLUP For PDPFP:

☐ DHSUD/HLURB copy of resolution approving the PDPFP
covering CY 2022
☐ RLUC Resolution/Certification recommending the
PDPFP’s approval/adoption of the Province
☐ Documentation (e.g., post-activity report) on the
communication of PDPFP to component LGUs and PDRRMC
or of their participation in the formulation

For CLUP:
☐ Sangguniang Panlalawigan Resolution for the approval
of the CLUP/ZO (for component cities and municipalities)

☐ Copy of DHSUD/HLURB Resolution for the approval of

the CLUP/ZO (for HUCs and ICCs)
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 Department of the Interior and Local Government
CY 2022 Seal of Good Local Governance

Data Available Documents

☐ Actual CLUP and Zoning Ordinance
☐ Documentation of communication of CLUP to barangays
and LDRRMC members or their participation in the process

If PDPFP/CLUP is still being drafted or under review:

☐ Copy of the draft PDPFP/CLUP
☐ Certification from Regional NEDA or RLUC or DHSUD if
PDPFP is under review
☐ Certification from PLUC or Regional HLURB or
Regional/Central DHSUD if CLUP is still under review

4. LDRRM plan and budget ☐ Approved LDRRM Plan

☐ Sanggunian resolution adopting LDRRM Plan
☐ 2022 Annual Investment Program
☐ Form 2C (Budget Office)
5. Local Climate Change Action Plan If LCCAP is separate plan:
☐ Approved LCCAP
☐ Sanggunian resolution adopting LCCAP (if separate
plan)
If LCCAP is integrated:
☐ Approved PDPFP/CLUP/CDP
☐ Sanggunian resolution adopting
PDPFP/CLUP/CDP
6. Contingency Plan approved by the LDRRMC ☐ Approved Contingency Plan for top 1 high risk hazard
☐ Approved Contingency Plan for top 2 high risk hazard
☐ Documentation indicating the updated CP (e.g. PAR,
working draft)
7. Utilization rate of LDRRMF’s 70% allocation for disaster ☐ Signed Report on Utilization of LDRRMF by the Local
prevention and mitigation, preparedness, response, Accountant
rehabilitation and recovery ☐ Certified Form 2A (Accounting Office)
☐ Report of LDRRMF utilization posted in the FDP Portal
☐ SRE – (Summary of Receipts and Expenditures)
☐ Budget Allocation (AIP or Supplemental Investment
Program) and Utilization
8. Early warning system ☐ Photo documentation of EWS (Certified Form 2E of DILG
Field Office)
☐ Sample publicly posted information on EWS
☐ EWS Standard Operating Procedures (SOP) or
documentation including a narration of the end-to-end use of
EWS
☐ Sample IEC materials on EWS on hazards, risks, and
vulnerabilities
9. Pre-emptive and forced evacuation mechanism ☐ Executive Order or equivalent issuance on the preemptive
and forced evacuation
10. Established Evacuation Management (EM) system and
resources
10.a. Evacuation Center ☐ List of evacuation centers
☐ MOA (covering CY 2021) with partner-schools or child
development centersAn actual evacuation center and its
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 Department of the Interior and Local Government
CY 2022 Seal of Good Local Governance

Data Available Documents

facilities
☐ Photo documentation of EC (Certified Form 2E of DILG
Field Office)
☐ Accomplished registration document for evacuees OR
system of registration stated in the SOP
☐ Copy of evacuation center information guide
☐ MOA for homes/businesses/ other private properties that
provide temporary shelter for some families
☐ Evacuation Center Management Plan
☐ Copy of EO or other issuance/document providing for the
camp/EC management committee and team
10.b. Evacuation information guide ☐ Certified Form 2F Disaster Risk Reduction and
Management Office
☐ Sample of actual Evacuation guides/maps
☐ Reports on the simulation exercises or drills/ tabletop
exercises
☐ Proof of conducted simulation exercises or drills within
the last three (3) years.
☐ Reports on the conduct of updating evacuation
guide/plan integrating minimum health standard protocol (if
applicable)
☐ Updated evacuation guides/plan integrating minimum
health standard protocol (if applicable)
10.c. Prepositioned goods and resources ☐ Inventory of stockpiled food packs and hygiene kits
☐ List of LGU-hired medical professionals
☐ List of LGU-hired professionals trained for psycho-social
support services and their training certificates
☐ Memorandum of Agreement or equivalent documents
(covering CYs 2020 and 2021) indicating arrangements with:
volunteer groups, supermarkets pharmacies, medical
groups, psycho-social professionals, transport groups, and
security system.
☐ Standard Operating Procedures or the Security Plan of the
PNP
☐ Inventory of trucks/vehicles and other transport services
(with photos)
☐ Photo Documentation (Certified Form 2E)
11. Equipped and trained Search and Rescue (SAR) or ☐ List of organized teams and personnel complement
Emergency Response (ER) teams ☐ Inventory of equipment
☐ Accomplishment report (with photos) of training provided
to SAR or ER teams from 2018 onwards
☐ Accomplishment report (with photos) of training
conducted by SAR or ER teams from 2018 onwards
☐ Certificate of Participation to trainings from 2018 onwards
12. . LDRRM Operations Center ☐ EO or similar issuance on the activation of LDRRM
OpCen in case it is temporary or functions 24/7
☐ OpCen Employee logbook
☐ SOP/OpCen manuals

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 Department of the Interior and Local Government
CY 2022 Seal of Good Local Governance

Data Available Documents

☐ Photo documentation (Certified Form 2E)
13. Incident Command System ☐ E.O or similar issuance establishing an incident command
system
☐ Copy of ICS Training Certificate issued by DND-OCD
☐ LDRRMO appointment of staff with ICS training/copy of
designation of said staff to LDRRM Office
☐ LGU ID of staff with ICS training
14. CBDRRM Plans [for cities and municipalities only] ☐ Certified Form 2F (LDRRMO)
☐ One (1) Sample CBDRRM Plan with corresponding BDC
resolution
☐ Approved 2022 Annual Investment Program
15. Participation in 2022 Gawad KALASAG (GK) Seal for ☐ Certificate of Compliance issued by OCD Regional Office
LDRRMCOs

Other Supporting Documents (to be supplied only if the listed documents are NOT yet available)
Data Available Documents

Prepared by: Certifying completeness of documentary

submission:

(Name and Signature) (Name and Signature)

DILG Field Officer DILG Cluster Head/LGPMS-RFP

Date signed: _____________________________ Date signed: ______________________________

4
Department of the Interior and Local Government
CY 2022 Seal of Good Local Governance

1
 Department of the Interior and Local Government Form 2.3
CY 2022 Seal of Good Local Governance Social Protection

Seal of Good Local Governance – DOCUMENTARY CHECKLIST

Form 2.3 Social Protection and Sensitivity

City/Municipality of : __________________________________ Income Class : _____________

Province : __________________________________ Region : _____________

INSTRUCTIONS: PLEASE READ BEFORE PROCEEDING TO THE ITEMS. Assigned DILG Field Officer: (1) This is the list
of documents which shall serve as basis in the provision of data for the RAT’s table assessment. (2)Tick the box before each
document to indicate availability. (3) For each available document other than the Certified Forms and photos, highlight the
portion, word or phrase that supports the data being required.

Data Available Documents

1. CY 2021 Seal of Child-friendly Local Governance [for ☐ Copy of Certificate from DSWD and DILG for 2021 Seal of
cities and municipalities only] Child-friendly Local Governance (SCFLG)

2. Mechanism for GAD ☐ EO or similar issuance institutionalizing LGU GAD Focal

Point System
☐ Ordinance approving/amending/revising LGU’s GAD Code
☐ Resolution localizing Provincial GAD Code
☐ GAD database or information management (printed,
electronic or online) system that generates gender statistics
and sex-disaggregated data
☐ CY 2021 and 2022 GAD Plan and Budget
☐ CY 2021 GAD Accomplishment Report
☐ Certified Form 2E (DILG Field Office)
☐ Certified Form 2A (Accountant)
☐ Certified Form 2H (Planning and Development Office)
3. Mechanism for VAWC [for cities and municipalities ☐ EO or similar issuance organizing LCAT-VAWC
only]: ☐ Percentage of barangays with VAWC desks (Certified
Form 2J Social Welfare and Development Office)
☐ Percentage of barangays with VAW Desks and Monitoring
Report of the Submission of Barangay Quarterly VAWC
Reports (Certified Form 2J Social Welfare and Development
Office)
4. Local Code for Children ☐ Ordinance approving/amending/revising LGU’s Code for
Children
☐ Ordinance localizing Provincial Code
☐ Copy of other Code or ordinance where Local Code for
Children is integrated
5. LGU Efforts on Early Childhood Care and Development ☐ Certified Form CM 2JA (Social Welfare and Development
(ECCD) [for cities and municipalities only] Office) submitted to DSWD field office
☐ Proof of transmittal of Certified Form CM 2JA to DSWD field
office

In case of inconsistency between LGU and DSWD data, RAT

must fill out the Change Request

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 Department of the Interior and Local Government
CY 2022 Seal of Good Local Governance

Data Available Documents

6. Accessibility for Persons with Disabilities and Older ☐ Form 2G: Photo Documentation and Information
Persons (Engineering Office)
☐ NHIP Certification for LG buildings declared as historical
sites
☐ Copy of building plan if LG building is under construction
7. Functionality of Persons with Disability Office (PDAO) ☐ Ordinance creating PDAO
☐ Executive Order or similar issuance appointing PDAO
Head/Focal Person
☐ Copy of Appointment of PDAO Head
☐ PRPWD-generated report on the PWDs issued with ID
☐ PDAO CY 2021 accomplishment report
☐ PDAO Citizen’s Charter indicating mechanism for the
issuance of persons with disability ID
8. Established senior citizens center [for cities and ☐ MOA between LGU and partner organization managing the
municipalities only] facility
☐ Form 2E: Photo Documentation
9. Indigenous Peoples Mandatory Representation in the ☐ Certificate of Affirmation received by IPMR
Sanggunian, if applicable ☐ NCIP-RO Hold-over resolution
☐ Copy of at least one payroll for CY 2021 and 2022
☐ Minutes of the Meetings for CY 2021 or CY 2022
10. Absence of illegal dwelling units OR LGU efforts for ☐ Certified Form 2H Planning and Development Office
resettlement of informal settlers [for cities only] (Status or accomplishment report on housing projects for CY
2021 target)
☐ Certified Form 2H Planning and Development Office
(Certification of LPDC on the presence of informal settlers and
efforts against informal settlements)
☐ Resolution adopting the City Shelter Plan
☐ Copy of Ordinance, EO or similar issuance creating a
Housing Office or task force/board
☐ Copy of Ordinance prohibiting illegal settlements,
relocation and/or reintegration of informal settlers
11. Fund utilization/ completion of PPAs in CY 2021 for: ☐ Certified Form 2A (Accounting Office) (Report on fund
a. Senior citizens and PWD utilization signed by the Local Accountant)
b. LCPC [for cities and municipalities only] ☐ Approved LGU Annual Plan and Budget
☐ Report on PPA completion signed by the LPDC
12. Implementation of Provision of Potable Water Supply- ☐ Certified Form 2A (Accounting Office)
Sagana at Ligtas na Tubig sa Lahat (SALINTUBIG) projects
13. DSWD-accredited LGU-managed residential care facility ☐ Accreditation of the facility issued by DSWD- Standards
[for provinces and HUCs only] Bureau

In case partner-facility is managed by DSWD Field Office:

☐ Accreditation issued by DSWD- Standards Bureau; and
☐ Proof of transfer of residents

In case partner-facility is private Social Welfare and

Development Agency (SWDA):

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 Department of the Interior and Local Government
CY 2022 Seal of Good Local Governance

Data Available Documents

☐ Accreditation of the facility issued by DSWD- Standards
Bureau; and
☐ Memorandum of Agreement between LGU and partner-
organization managing the facility

14. Functionality of LSWDO ☐ Appointment of P/C/MSWDO with CSC-attestation (In case

the LGU is accredited, the CSC Resolution granting the LGU
authority to take final action on its appointment)
☐ PRC license of LSWDO or staff in case of exemption

In case the exemption applies:

☐ PRC license of RSW LSWDO staff

☐ CBMS database or other database/tracking system

☐ Manual of Operations, Citizen’s Charter, EO, or Ordinance
indicating local guidelines on a case management system/s
on programs adopted
15. Adopted local policy on social protection ☐ EO, Ordinance or resolution related to social protection

16. Institutionalized Public Employment Service Office ☐ Copy of Ordinance creating PESO
☐ Appointment/Designation of PESO Manager
17.a. Functionality of a Local Development Council ☐ Executive Order or Resolution creating the LDC (with
names of member-CSOs and official representatives)
☐ LDC Minutes of the Meetings for CY 2021
☐ Executive Order creating LDC Executive Committee
☐ Executive Order creating/organizing the Local Project
Development Committee

For Socio-economic plans and policies:

☐ Sanggunian resolution approving CDP
☐ Sanggunian resolution approving LDIP
☐ Sanggunian resolution approving AIP

17.b. Satisfactory participation of civil society organizations ☐ Executive Order or Resolution creating the LDC (with
(CSOs) in LDC names of member-CSOs and official representatives
☐ List of organized and accredited CSOs
☐ LDC Minutes of Meetings
☐ CSO Plan of Action, if any
☐ Documentation of workshops on project prioritization
conducted in CY 2021, if any
☐ Post-activity report, if any
☐ Project monitoring report, if any

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 Department of the Interior and Local Government
CY 2022 Seal of Good Local Governance

Other Supporting Documents (to be supplied only if the listed documents are NOT yet available)
Data Available Documents

Prepared by: Certifying completeness of documentary

submission:

(Name and Signature) (Name and Signature)

DILG Field Officer DILG Cluster Head/LGPMS-RFP

Date signed: _____________________________ Date signed: ______________________________

4
 Department of the Interior and Local Government Form 2.4
CY 2022 Seal of Good Local Governance Health Compliance and
Responsiveness

Seal of Good Local Governance – DOCUMENTARY CHECKLIST

Form 2.4 Health Compliance and Responsiveness

City/Municipality of : __________________________________ Income Class : _____________

Province : __________________________________ Region : _____________

INSTRUCTIONS: PLEASE READ BEFORE PROCEEDING TO THE ITEMS. Assigned DILG Field Officer: No documents
shall be prepared, NGA data will be used for all indicators. Kindly fill out the second column only if local data differ from the
NGA data.

Data Available Documents

(in case local data differ from NGA data)
1. Complete Local Investment Plan for Health (LIPH)
2. Equal or below mean-benchmark in stunting rate
among children under-five
3. At least 47.5% of households have access to safely-
managed drinking water services
4. CY 2020 rate is equal to, or above 2019 benchmark for
TB Case Notification Rate

5. CY 2020 rate equal to, or above 2019 benchmark for

TB Treatment Success Rate
6. Institutionalized DRMM-H system
7. Functional local Epidemiology Surveillance Unit

Other Supporting Documents (to be supplied only if the listed documents are NOT yet available)
Data Available Documents

Prepared by: Certifying completeness of documentary

submission:

(Name and Signature) (Name and Signature)

DILG Field Officer DILG Cluster Head/LGPMS-RFP

Date signed: _____________________________ Date signed: ______________________________

1
 Department of the Interior and Local Government Form 2.5
CY 2022 Seal of Good Local Governance Sustainable Education

Seal of Good Local Governance – DOCUMENTARY CHECKLIST

Form 2.5 Sustainable Education

City/Municipality of : __________________________________ Income Class : _____________

Province : __________________________________ Region : _____________

INSTRUCTIONS: PLEASE READ BEFORE PROCEEDING TO THE ITEMS. Assigned DILG Field Officer: (1) This is the list
of documents which shall serve as basis in the provision of data for the RAT’s table assessment. (2)Tick the box before each
document to indicate availability. (3) For each available document other than the Certified Forms and photos, highlight the
portion, word or phrase that supports the data being required.

Data Available Documents

1. Functional local school board

1a Composition ☐ EO or similar issuance creating the LSB

1b Meetings ☐ Minutes of the Meeting of LSB in CY 2021
☐ Certified Form 2D accomplished by Schools Division
Superintendent or the District Supervisor (DepEd)
☐ Copy of Justification Letter indicating the reasons for the
conduct of only six to eleven LSB meetings (if applicable)

2. Conduct of PAPs with external partners ☐ Accomplishment report signed by LGU and/or external
partner
☐ Partnership Agreements [e.g., Memorandum of Agreement
(MOA) and Memorandum of Understanding (MOU)]
3. Fund utilization rate of PAPs funded by CY 2021 SEF ☐ Certified Form 2D (Certification from DepEd
budget Representative)
☐ CY 2021 Accomplishment Report of LSB Plan/SEF Budget
☐ CY 2021 Financial Report of LSB Plan/SEF Budget
4. LGU-initiated planned reforms ☐ Certified Form CM/P 2D (Certification from DepEd
Representative)
☐ Approved SEF Budget Preparation Form No. 01
5. Support to program and projects (inclusive education) ☐ Accomplishment Report from the LGU
☐ DepEd reports on program implementation review
For Profiling ☐ SGLG Form CM 2D.2 DepEd Representatives (for cities
with DepEd City SDO) or
☐ SGLG Form CM 2D.3 DepEd Representative (for cities
with no DepEd City SDO and Municipalities)

Other Supporting Documents (to be supplied only if the listed documents are NOT yet available)
Data Available Documents

1
 Department of the Interior and Local Government
CY 2022 Seal of Good Local Governance

Prepared by: Certifying completeness of documentary

submission:

(Name and Signature) (Name and Signature)

DILG Field Officer DILG Cluster Head/LGPMS-RFP

Date signed: _____________________________ Date signed: ______________________________

2
 Department of the Interior and Local Government Form 2.6
CY 2022 Seal of Good Local Governance Business-friendliness and
Competitiveness

Seal of Good Local Governance – DOCUMENTARY CHECKLIST

Form 2.6 Business-friendliness and Competitiveness

City/Municipality of : __________________________________ Income Class : _____________

Province : __________________________________ Region : _____________

INSTRUCTIONS: PLEASE READ BEFORE PROCEEDING TO THE ITEMS. Assigned DILG Field Officer: (1) This is the list
of documents which shall serve as basis in the provision of data for the RAT’s table assessment. (2)Tick the box before each
document to indicate availability. (3) For each available document other than the Certified Forms and photos, highlight the
portion, word or phrase that supports the data being required.

Data Available Documents

1a. Finalist of the PCCI's Most Business-Friendly LGUs Award ☐ Copy of Recognition received from PCCI
1b. Ranked among the Top 20 Provinces/ Cities/ ☐ Copy of Recognition received from DTI-CB
Municipalities in the CY 2020 Competitiveness Index
2. Presence of local economic development and investment ☐ Ordinance creating LEDIP Office/Unit
promotion office ☐ Executive order or similar issuance designating a
LEDIPO with listed functions, duties and responsibilities
3. Presence of citizen’s charter for securing permits for new ☐ Form 2E: Photo Documentation
business and business renewal ☐ Updated Citizen’s Charter
[for cities and municipalities only] ☐ Ordinance or similar issuance adopting citizen’s charter
4. Streamlined process in doing business ☐ Certified Form 2B (BPLO)
[for cities and municipalities only] ☐ Citizen’s Charter
☐ Sample transactions for renewal and new businesses for
2021
Business One Stop-Shop [for cities and municipalities ☐ Memorandum of Agreement or any document that
only] proves the establishment of BOSS (seasonal or all-year
round)
5. Updated Local Economic Development (LED) data ☐ Certified Form 2B (BPLO) for the summarized data
[for cities and municipalities only] ☐ Actual Database or electronically generated report
where business application forms are tracked and
summarized
6. Local Investment Incentive Code [for provinces and cities ☐ Ordinance adopting the LIIC
only] ☐ Ordinance amending/ revising particular section(s) of
existing LIIC
☐ PPP Code/JV Code/PEZA Code (as applicable)

Other Supporting Documents (to be supplied only if the listed documents are NOT yet available)
Data Available Documents

1
 Department of the Interior and Local Government
CY 2022 Seal of Good Local Governance

Prepared by: Certifying completeness of documentary

submission:

(Name and Signature) (Name and Signature)

DILG Field Officer DILG Cluster Head/LGPMS-RFP

Date signed: _____________________________ Date signed: ______________________________

2
 Department of the Interior and Local Government Form 2.7
CY 2022 Seal of Good Local Governance Safety, Peace and Order

Seal of Good Local Governance – DOCUMENTARY CHECKLIST

Form 2.7 Safety, Peace and Order

City/Municipality of : __________________________________ Income Class : _____________

Province : __________________________________ Region : _____________

INSTRUCTIONS: PLEASE READ BEFORE PROCEEDING TO THE ITEMS. Assigned DILG Field Officer: (1) This is the list
of documents which shall serve as basis in the provision of data for the RAT’s table assessment. (2)Tick the box before each
document to indicate availability. (3) For each available document other than the Certified Forms and photos, highlight the
portion, word or phrase that supports the data being required.

Data Available Documents

1. Provision of logistical support to the PNP ☐ Certified Form 2I (Local PNP)
2. Organized and trained BPATs, barangay tanods, ☐ Certified Form 2I (Local PNP)
and/or any similar unit [for cities and municipalities ☐ List of barangays with organized BPATs, barangay tanods,
only] and/or other similar units
☐ List of barangays with trained BPATs, barangay tanods,
and/or other similar units
3. Drug-cleared barangays [for cities and municipalities ☐ Certification of drug-cleared barangay per DDB Res. No. 3
only] s.2017
4.
5. Firecracker and pyrotechnic devices regulation [for ☐ Ordinance or similar issuance stating total ban of
cities and municipalities only] firecrackers and pyrotechnic devices OR designating specific
zones for manufacturing, display and exhibition of firecrackers

Other Supporting Documents (to be supplied only if the listed documents are NOT yet available)
Data Available Documents

Prepared by: Certifying completeness of documentary

submission:

(Name and Signature) (Name and Signature)

DILG Field Officer DILG Cluster Head/LGPMS-RFP

Date signed: _____________________________ Date signed: ______________________________

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Department of the Interior and Local Government
CY 2022 Seal of Good Local Governance

4
 Department of the Interior and Local Government Form 2.8
CY 2022 Seal of Good Local Governance Environmental Management

Seal of Good Local Governance – DOCUMENTARY CHECKLIST

Form 2.8 Environmental Management

City/Municipality of : __________________________________ Income Class : _____________

Province : __________________________________ Region : _____________

INSTRUCTIONS: PLEASE READ BEFORE PROCEEDING TO THE ITEMS. Assigned DILG Field Officer: (1) This is the list
of documents which shall serve as basis in the provision of data for the RAT’s table assessment. (2)Tick the box before each
document to indicate availability. (3) For each available document other than the Certified Forms and photos, highlight the
portion, word or phrase that supports the data being required.

Data Available Documents

1. Convened local solid waste management board ☐Copy of Executive Order or similar issuance creating the
SWM Board
☐ Minutes of the meeting in CY 2021
2. No operating open and/or controlled dumpsite [for cities ☐ Certified Form 2M (Local ENRO)
and municipalities only] ☐ Approved Safe Closure and Rehabilitation Plan
☐ Certification/Inspection Report from DENR-EMB regional
office stating that LGU’s dumpsite is already closed (for those
with operating dumpsite per DENR-EMB CO data)
☐ Dumpsite closure inspection report by DENR EMB
Regional Office (for those with operating dumpsite per DENR-
EMB CO data)

3. Approved 10-Year Solid Waste Management Plan ☐ Copy of NSWMC Resolution approving the LGU’s SWM
Plan
☐ Approved SWM Plan

In case the plan is still under review of NSWMC:

☐ Received copy of LGU’s letter submitting its Plan for

NSWMC’s review

4. Materials Recovery Facility [for cities and municipalities ☐ Form 2E: Photo Documentation
only] ☐ Certified Form 2M (Local ENRO)
☐ Actual MRF
☐ If facility is in partnership with a private entity:
Memorandum of Agreement
5. Access to sanitary landfill [for cities and municipalities ☐ Certified Form 2M from the Local Environment and Natural
only] Resources Office on the LGU’s access to SLF

If in partnership with another LGU’s or private entity’s landfill:

☐ Memorandum of Agreement

☐ Photo documentation of actual temporary Residual

Containment Area (Certified Form 2E of DILG Field Office)

In case of ongoing construction of sanitary landfill:

☐ Project progress report(s)

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 Department of the Interior and Local Government
CY 2022 Seal of Good Local Governance

In case of other means of residual waste final disposal:

☐ Proof that said technology officially recognized by DENR

as an alternative sanitary landfill

Other Supporting Documents (to be supplied only if the listed documents are NOT yet available)
Data Available Documents

Prepared by: Certifying completeness of documentary

submission:

(Name and Signature) (Name and Signature)

DILG Field Officer DILG Cluster Head/LGPMS-RFP

Date signed: _____________________________ Date signed: ______________________________

2
 Social Protection

Department of the Interior and Local Government Form 2.9

CY 2022 Seal of Good Local Governance Tourism, Heritage
Development, Culture
and the Arts

Seal of Good Local Governance – DOCUMENTARY CHECKLIST

Form 2.9 Tourism, Heritage Development, Culture and the Arts

City/Municipality of : __________________________________ Income Class : _____________

Province : __________________________________ Region : _____________

INSTRUCTIONS: PLEASE READ BEFORE PROCEEDING TO THE ITEMS. Assigned DILG Field Officer: (1) This is the list
of documents which shall serve as basis in the provision of data for the RAT’s table assessment. (2)Tick the box before each
document to indicate availability. (3) For each available document other than the Certified Forms and photos, highlight the
portion, word or phrase that supports the data being required.

Data Available Documents

1. Tourism Development
1.1. Presence of a local tourism office or officer ☐ Certified Form 2H (PDO)
☐ EO or similar issuance creating a local tourism office or
designating an officer for tourism development and
promotion with listed functions, duties and responsibilities
☐ Appointment of local tourism officer with CSC attestation
1.2. Tourist information and assistance center or desks ☐ Form 2E: Photo Documentation (DILG Field Office)
☐ Ordinance or similar issuance creating the tourist
information and assistance center or desk
1.3. Tracking system of tourism data ☐Tourism Statistics (Certified Form 2N of Designated
Tourism Officer)
☐ Database or record book where tourism data are tracked
and summarized (scanned copy)
☐ Form 2E: Photo Documentation of the actual tracking
system
2. Cultural Heritage Promotion and Conservation
2.1. Presence of a local council for culture and the arts ☐ Copy of Sanggunian Resolution or similar issuance
creating a local council for culture and the arts
2.2. Utilization of the budget appropriated for the ☐ Certified form 2A (Accounting Office)
conservation and preservation of cultural property, ☐ Copy of 2021 Annual budget
CY 2021 ☐ Copy of 2021 Annual Investment Program
2.3. Presence of a Cultural property inventory/registry in ☐ Inventory of cultural property
the LGU ☐ Letter of acknowledgement from NCCA
2.4. Published narrative of history and culture ☐ Copy of published narrative of history and culture
☐ Form 2E: Photo Documentation
☐ Proof of LGU acknowledging narrative published by a
third party

Other Supporting Documents (to be supplied only if the listed documents are NOT yet available)
Data Available Documents

1
 Department of the Interior and Local Government
CY 2022 Seal of Good Local Governance

Prepared by: Certifying completeness of documentary

submission:

(Name and Signature) (Name and Signature)

DILG Field Officer DILG Cluster Head/LGPMS-RFP

Date signed: _____________________________ Date signed: ______________________________

2
 Department of the Interior and Local Government Form 2.10
CY 2022 Seal of Good Local Governance Youth Development

Seal of Good Local Governance – DOCUMENTARY CHECKLIST

Form 2.10 Youth Development

City/Municipality of : __________________________________ Income Class : _____________

Province : __________________________________ Region : _____________

INSTRUCTIONS: PLEASE READ BEFORE PROCEEDING TO THE ITEMS. Assigned DILG Field Officer: (1) This is the list
of documents which shall serve as basis in the provision of data for the RAT’s table assessment. (2)Tick the box before each
document to indicate availability. (3) For each available document other than the Certified Forms and photos, highlight the
portion, word or phrase that supports the data being required.

Data Available Documents

1. Functional youth development council
1.1. Composition ☐ Executive order or similar issuance creating the LYDC
1.2. Meetings ☐ LYDC Minutes of the Meetings for 2021
1.3. Training ☐ Training Certificates
☐ Post-Activity Report / Highlights of the training with
photo documentation
2. Established youth development office
2.1. Designated officer ☐ Appointment of LYDO Officer – Head of Office with CSC
attestation
☐ Executive Order or similar issuance for designation of
LYDO Officer

For cases with CSC appointments:

☐ CSC Resolution granting the LGU authority to take final

action on its appointment, in case the LGU is accredited
☐ Letter for CSC Field Office transmitting copy, and
requesting attestation of appointment, in case LGU is not
accredited
2.2. Database of youth organizations ☐ Updated list of youth organizations or youth serving
organizations registered and verified under YORP
☐ Process Flow of Registration (or has at Revitalized
YORP Guidelines on hand, if localized flow is not
available)
☐ List of Registration Certificates issued to Youth
Organizations
2.3. At least 50% utilization of appropriated CY 2021 ☐ Certified Form 2A (Accounting Office)
budget for youth development ☐ CY 2021 Approved Annual Work and Financial Plan
(WFP) for LYDO signed by LCE and Budget Officer,
supported by a Resolution from the LDC
2.4. Provided TA in conduct of training for SK and LYDC ☐ Post-Activity Report / Highlights of the training with
members photo documentation
3. Local youth development plan ☐ Approved LYDP with LYDC Resolution approving the
LYDP
☐ Approved CDP

If LGU has no approved LYDP:

☐ LYDC Certification that final draft of LYDP is
1
 Department of the Interior and Local Government
CY 2022 Seal of Good Local Governance

Data Available Documents

currently under review
☐ Received copy of letter from SK Federation
transmitting copy of final draft LYDP to LYDC for
review
4. LGU support to youth development
4.a. Policy on Youth Development ☐ Ordinances / Resolutions on Youth Development or
adoption of local youth anti-poverty agenda
4.b. Youth Development Facilities ☐ Photo-documentation of the youth development
facility/ies or designated space/s (Certified Form 2E of
DILG Field Office)
4.c. Program for Youth Development ☐ Post Activity Report of the youth-related program or
service conducted by any LGU office (aside from LYDO)

Other Supporting Documents (to be supplied only if the listed documents are NOT yet available)
Data Available Documents

Prepared by: Certifying completeness of documentary

submission:

(Name and Signature) (Name and Signature)

DILG Field Officer DILG Cluster Head/LGPMS-RFP

Date signed: _____________________________ Date signed: ______________________________