Form 2.

1
Department of the Interior and Local Government Financial Administration
CY 2023 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 2021 Annual Audit Report by the
Commission on Audit
LGU’s CY 2022 Annual Audit Report by the
Commission on Audit

2. Compliance with the Full Disclosure Policy for CY 2022 2nd Form 2E: Photo Documentation
to 4th quarters and CY 2023 1st quarter, posting in 3
conspicuous places and FDP portal

3. Utilization rate of funding assistance from the Local Certified Form 2A (Accounting Office)
Government Support Fund (LGSF), if applicable
Data on utilization of LGSF funds CY 2021 from
SubayBayan
Certified Form 2E.1 (DILG Field Officer), in case of
data corrections

4. Approved CY 2023 annual budget Ordinance enacting and approving the LGU’s CY
2023 annual budget

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

Data Available Documents

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1
 Department of the Interior and Local Government
CY 2023 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-SGLG RFP

Date signed: ___________________________ Date signed: ____________________________

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 Form 2.2
Department of the Interior and Local Government Disaster Preparedness
CY 2023 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 2022

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

For cases with consideration:

Appointment documents of retired/resigned LDRRMO
Head (attested/approved thru CSC Resolution on Authority to
approve appointments)
Proof of separation from service
Proof of posting of vacancy
Executive Order or similar issuance for designation of
LDRRMO Head

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 Department of the Interior and Local Government
CY 2023 Seal of Good Local Governance

Data Available Documents

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 and/or CY 2023
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)
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/Central DHSUD if
CLUP is still under review

4. LDRRM plan and budget Approved LDRRM Plan

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 Department of the Interior and Local Government
CY 2023 Seal of Good Local Governance

Data Available Documents

Sanggunian resolution adopting LDRRM Plan

Approved 2022 and/or 2023 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 CLUP/CDP
Sanggunian resolution adopting 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
LDRRMC-approved Contingency Plan for COVID-EREID
concerns (as the case may be)

7. Utilization rate of LDRRMF’s 70% allocation for disaster Certified Form 2A (Accounting Office)
prevention and mitigation, preparedness, response,
rehabilitation and recovery
Certified Form 2F (LDRRMO)
SRE – (Summary of Receipts and Expenditures)
Report of LDRRMF utilization posted in the FDP Portal
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 pre-emptive
and forced evacuation

10. Established Evacuation Management (EM) system and

resources

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 Department of the Interior and Local Government
CY 2023 Seal of Good Local Governance

Data Available Documents

10.a. Evacuation Center List of evacuation centers

MOA/MOU (covering CY 2022 or 2023) with partner-
schools or child development centers
Photo documentation of EC (Certified Form 2E of DILG
Field Office)
Accomplished registration document for evacuees OR
system of registration stated in the SOP or similar
document
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 CY 2022 or 2023) 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

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 Department of the Interior and Local Government
CY 2023 Seal of Good Local Governance

Data Available Documents

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
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 2023 Annual Investment Program

15. Participation and compliance with the submission of Certificate of Compliance issued by OCD Regional Office
required documents in the 2023 Gawad Kalasag (GK)
Seal for LDRRMCOs

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

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7
 Department of the Interior and Local Government
CY 2023 Seal of Good Local Governance

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Prepared by: Certifying completeness of documentary submission:

(Name and Signature) (Name and Signature)

DILG Field Officer DILG Cluster Head/LGPMS-SGLG RFP

Date signed: _____________________________ Date signed: ______________________________

8
 Department of the Interior and Local Government Form 2.3
CY 2023 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 2022 Seal of Child-friendly Local Governance [for Copy of Certificate from DSWD and DILG for 2022 Seal of
cities and municipalities only] Child-friendly Local Governance (SCFLG)

2. Mechanisms 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 2022 and 2023 GAD Plan and Budget
CY 2022 GAD Accomplishment Report
Certified Form 2E (DILG Field Office)
Certified Form 2A (Accountant)
Certified Form 2H (Planning and Development Office)
3. Mechanisms for VAWC [for cities and municipalities EO or similar issuance organizing LCAT-VAWC
only]:
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 [for provinces only] Ordinance approving/amending/revising LGU’s Code for
Children
Copy of other Code or ordinance where Local Code for
Children is integrated

9
 Department of the Interior and Local Government
CY 2023 Seal of Good Local Governance

Data Available Documents

5. 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
Copy of plan (stand-alone) to be implemented in the next
3 years for the primary health facility
Copy of plan/investment program/annual budget with the
proposed PAPs for the primary health facility

6. Functionality of Persons with Disability Office (PDAO) Ordinance/EO 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 2022 accomplishment report
PDAO Citizen’s Charter indicating mechanism for the
issuance of persons with disability ID

7. Sign language interpreter in every LGU [for HUCs only] Appointment document designating sign language
interpreter
Documents as proof of hiring sign language interpreter
Annual Investment Plan
Annual Budget
Proof of engagement with external service provider (e.g.
MOU etc.)

8. Established Senior Citizens Center [for cities and MOA between LGU and partner organization managing
municipalities only] the facility
Form 2E: Photo Documentation
9. Indigenous Peoples Mandatory Representation in the Certificate of Affirmation received by IPMR
Sanggunian, if applicable
Copy of at least one payroll for CY 2022 or 2023
Minutes of the Meetings for CY 2022 or CY 2023
NCIP-RO Hold-over resolution

10. Absence of illegal dwelling units OR LGU efforts for Certified Form 2H Planning and Development Office
resettlement of informal settlers [for cities only] (Certification of LPDC on the presence of informal settlers and
efforts against informal settlements and Status or
accomplishment report on housing projects for CY 2022
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 Department of the Interior and Local Government
CY 2023 Seal of Good Local Governance

Data Available Documents

target)
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 PAPs in CY 2022 for: Certified Form 2A (Accounting Office) (Report on fund
utilization signed by the Local Accountant)
a. Senior citizens and PWD
Approved LGU Annual Plan and Budget
b. LCPC [for cities and municipalities only]
Report on PAPs completion signed by the LPDC (Certified
Form 2H Planning and Development Office)
12.DSWD or BARMM MSSD-accredited LGU-managed Accreditation of the facility issued by DSWD- Standards
residential care facility [for provinces and HUCs only] Bureau or BARMM MSSD

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

Accreditation issued by DSWD- Standards Bureau or
BARMM MSSD; and
Proof of transfer of residents

In case partner-facility is private Social Welfare and

Development Agency (SWDA):
Accreditation of the facility issued by DSWD- Standards
Bureau or BARMM MSSD; and
Memorandum of Agreement between LGU and partner-
organization managing the facility
Copy of valid Certification if LGU is not listed in NGA data

13. Efforts to strengthen the 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
Any proof of granting Magna Carta benefits (e.g. Annual
Budget, payroll)

In case the exemption applies:

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 Department of the Interior and Local Government
CY 2023 Seal of Good Local Governance

Data Available Documents

PRC license of RSW LSWDO staff

CBMS database or other database or other

database/tracking system that can help identify individuals and
households who will be beneficiaries of social protection
interventions.
Proof of LGU efforts to implement CBMS (e.g. CBMS-
related PAPs in Annual Budget, etc.)
Manual of Operations, Citizen’s Charter, EO, or Ordinance
indicating local guidelines on a case management system/s
on programs adopted

14. LGU Efforts on mainstreaming social protection Social Protection Development Report developed in CY
2019 or later

15. Institutionalized Public Employment Service Office Copy of Ordinance creating PESO
Appointment/Designation of PESO Manager
2023 Annual Budget
Certification from Budget Officer indicating that the LGU
has met the PS limitation
Certified Form 2C (Budget Officer)

16.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 2022
Executive Order creating LDC Executive Committee
Executive Order creating/organizing the Local Project
Monitoring Committee

For Socio-economic plans and policies:

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

16.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 in CY 2022

12
 Department of the Interior and Local Government
CY 2023 Seal of Good Local Governance

Data Available Documents

CSO Plan of Action, if any

Documentation of workshops on project prioritization
conducted in CY 2022, if any
Post-activity report, if any
Project monitoring report, if any

17. Establishment of Population Office with appointed or Certified Form 2E (Photo documentation)
designated Population Officer/Coordinator
Appointment/Designation of Population
Officer/Coordinator

18. Setting-up of a Teen Center (community or school- ● Copy of ordinance or similar issuance for the creation and
based) establishment of a Teen Center
● Certified Form 2E (Photo documentation)

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

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Prepared by: Certifying completeness of documentary submission:

(Name and Signature) (Name and Signature)

DILG Field Officer DILG Cluster Head/LGPMS-SGLG RFP

Date signed: _____________________________ Date signed: ______________________________

13
Department of the Interior and Local Government
CY 2023 Seal of Good Local Governance

14
 Department of the Interior and Local Government Form 2.4
CY 2023 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 (clerical errors only)

Data Available Documents

(in case local data differ from NGA data due to clerical errors
only)

1. Complete Local Investment Plan for Health (LIPH) Click here to enter text.

2. 55% of households using safely managed drinking- Click here to enter text.
water services

3. At least 43.60% of Households using safely managed Click here to enter text.
sanitation services

4. CY 2021 performance result is equal or above the CY Click here to enter text.
2020 performance result for TB Case Notification Rate

5. More than or equal to 90% TB Treatment Success Rate Click here to enter text.
6. At least 60-110% OPT Plus coverage and stunting Click here to enter text.
prevalence within the medium level of public health
significance

7. Institutionalized DRRM-H System with the presence of Click here to enter text.
all four DRRM-H components

8. Functional Epidemiology and Surveillance Unit (ESU) Click here to enter text.
with all ESU components present

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

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15
 Department of the Interior and Local Government
CY 2023 Seal of Good Local Governance

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Prepared by: Certifying completeness of documentary submission:

(Name and Signature) (Name and Signature)

DILG Field Officer DILG Cluster Head/LGPMS-SGLG RFP

Date signed: _____________________________ Date signed: ______________________________

16
 Department of the Interior and Local Government Form 2.5
CY 2023 Seal of Good Local Governance Sustainable Education

Seal of Good Local Governance – DOCUMENTARY CHECKLIST Form 2.3

Social Protection
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 2022

Certified Form 2D accomplished by Schools Division
Superintendent or the District Supervisor (DepEd)

2. Conduct of PAPs with external partners Accomplishment report signed by LGU and/or external
partner
Partnership Agreements [i.e., Memorandum of Agreement
(MOA) and Memorandum of Understanding (MOU)]

3. Fund utilization rate of PAPs funded by CY 2022 SEF Certified Form 2D (Certification from DepEd
budget Representative)
CY 2022 Accomplishment Report of LSB Plan/SEF Budget
CY 2022 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 (for Presence of Out-Of-School Youth and SGLG Form CM/P 2D.2 (Certification from DepEd SDO)
Incidence of Bullying)

Other Supporting Documents (to be supplied only if the listed documents are NOT yet available)
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 Department of the Interior and Local Government
CY 2023 Seal of Good Local Governance

Data Available Documents

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Certifying completeness of documentary submission:

Prepared by:

(Name and Signature) (Name and Signature)

DILG Field Officer DILG Cluster Head/LGPMS-SGLG RFP

Date signed: _____________________________ Date signed: ______________________________

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 Department of the Interior and Local Government Form 2.6
CY 2023 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 2022 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] Form 2E: Photo Documentation
Citizen’s Charter
Sample transactions for renewal and new businesses for
2022
City Ordinance on the integration of barangay clearance
to the business permitting process.
Barangay Ordinance or similar issuance authorizing
the city to collect barangay clearance fee
Sample order of payment reflecting barangay clearance
fees
Memorandum of Agreement or any document that
proves the establishment of BOSS (seasonal or all-year
round)

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 Department of the Interior and Local Government
CY 2023 Seal of Good Local Governance

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

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Prepared by: Certifying completeness of documentary submission:

(Name and Signature) (Name and Signature)

DILG Field Officer DILG Cluster Head/LGPMS-SGLG RFP

Date signed: _____________________________ Date signed: ______________________________

20
 Department of the Interior and Local Government
CY 2023 Seal of Good Local Governance

Form 2.7
Safety, Peace and Order

Seal of Good Local Governance – DOCUMENTARY CHECKLIST

21
 Department of the Interior and Local Government
CY 2023 Seal of Good Local Governance

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, and/or Certified Form 2I (Local PNP)
any similar unit [for cities and municipalities only]
List of barangays with organized BPATs, barangay tanods,
and/or other similar units
List of barangays with trained BPATs, barangay tanods,
and/or other similar units

3. 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

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22
 Department of the Interior and Local Government
CY 2023 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-SGLG RFP

Date signed: _____________________________ Date signed: ______________________________

23
 Department of the Interior and Local Government Form 2.8
CY 2023 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 2022
Certification from LG-ENRO and BPLO if there is no
recycling industry and manufacturing or packaging industry

2. Has not operated an open or controlled dumpsite [for Certified Form 2M (Local ENRO)
cities 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)
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)
Sample recording system
If facility is in partnership with a private entity:
Memorandum of Agreement
For clustering of MRF among barangay: Memorandum of

24
 Department of the Interior and Local Government
CY 2023 Seal of Good Local Governance

Understanding/ Agreement
For Central MRF: a recording system should indicating that
it can cater the recyclable and biodegradable wastes from all
its component barangays/cluster of barangays

5. Access to sanitary landfill and segregated collection of Certified Form 2M from the Local ENRO
wastes [for cities and municipalities only]
Photo documentation of actual temporary Residual
Containment Area and SLF (Certified Form 2E of DILG Field
Office)
Memorandum of Agreement
Project progress report(s)
Approved SWM Plan
Ordinance for the segregated collection
Schedule of collection
SWM Self Compliance Monitoring and Auditing Report
Proof of DENR’s recognition that the LGU’s
facility/technology/initiatives lead to zero residual wastes OR
completely address its residual wastes (in case of other
means of residual waste final disposal)
6. Initiatives contributing to biodiversity conservation and Ordinance establishing wetland/s or water body as
enhancement focusing on inland wetlands and water conservation area or with protection purposes
bodies
Ecological Profile
Relevant comprehensive and thematic plans and
investment programs that should be approved/ adopted by the
LGU (e.g., PDPFP, CLUP, CDP, FLUP, LCCAP, LDIP, AIP)
Sanggunian-adopted Management plan for an inland
wetland or waterbody
Accomplishment report on the program or project
conducted on biodiversity conservation and enhancement or
water quality management in CY 2022 or 2023
Wetland information sheet (technical assistance from
DENR regional offices)

7. Initiatives on Water Quality Management Water Quality Monitoring Results

EO or other issuance creating the Water Quality Monitoring
Unit
Copy of AIP

25
 Department of the Interior and Local Government
CY 2023 Seal of Good Local Governance

Copy of LDIP

Accomplishment Report on the program/project activity

conducted on water quality management and monitoring

Request for DENR EMB’s technical assistance on water

quality monitoring
WQMA Accomplishment Report (for LGU WQMA
Members)
Compliance scheme or localized Water Quality
Management Area Action Plan (for LGU WQMA Members)
WQMA Governing Board Resolution (for LGU WQMA
Members)

8. Establishment or Maintenance of Public Parks and Ecological Profile

Green Spaces
Relevant comprehensive and thematic plans and
investment programs that should be approved/ adopted by the
LGU (e.g., PDPFP, CLUP, CDP, FLUP, LCCAP, LDIP, AIP)
Form 2E: Photo Documentation
Site profile and assessment of public parks and green
spaces
Ordinance supporting the establishment and maintenance
of a public park/green open space
Accomplishment Report of Program or project conducted
for public parks and green spaces

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

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26
 Department of the Interior and Local Government
CY 2023 Seal of Good Local Governance

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Prepared by: Certifying completeness of documentary submission:

(Name and Signature) (Name and Signature)

DILG Field Officer DILG Cluster Head/LGPMS-SGLG RFP

Date signed: _____________________________ Date signed: ______________________________

27
 Department of the Interior and Local Government Form 2.9
CY 2023 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 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
Certified Form 2H (PDO)
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. Formulation of Local Tourism Development Plan Approved Local Tourism Development Plan
Approved resolution or executive order creating the
Tourism Development Plan Committee or Technical
Working Group
Approved Work Plan for the formulation of the Tourism
Development Plan
Copy of draft Local Tourism Development Plan

1.4. Submission of Annual Supply Tourism Statistics Annual Supply Tourism Statistics Report for CY 2022
Report
Copy of transmittal of Annual Supply Tourism Statistics
Report for CY 2022
Supply Database for Accommodation Establishments
(SAE1)
Supply Database for Tourist Attractions (STA)
Supply Database for other Tourism Enterprises (STE)

28
 Department of the Interior and Local Government
CY 2023 Seal of Good Local Governance

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 2022 Annual budget
CY 2022
Copy of 2022 Annual Investment Program

2.3. Presence of an updated Cultural property Updated Inventory of cultural property

inventory/registry in the LGU, as of CY 2022
Letter of acknowledgment from NCCA
Proof of transmittal of inventory to 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

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Prepared by: Certifying completeness of documentary submission:

29
 Department of the Interior and Local Government
CY 2023 Seal of Good Local Governance

(Name and Signature) (Name and Signature)

DILG Field Officer DILG Cluster Head/LGPMS-SGLG RFP

Date signed: _____________________________ Date signed: ______________________________

30
 Department of the Interior and Local Government Form 2.10
CY 2023 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 2022

1.3. Training Training Certificates

Post-Activity Report / Highlights of the training with photo
documentation

2. Established youth development office

2.1. Plantilla LYD 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 as of CY
2022
Process Flow of Registration (or has at Revitalized
YORP Guidelines on hand, if localized flow is not

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 Department of the Interior and Local Government
CY 2023 Seal of Good Local Governance

Data Available Documents

available)
List of Registration Certificates issued to Youth
Organizations

2.3. At least 75% utilization of appropriated CY 2022 Certified Form 2A (Accounting Office)
budget for youth development
CY 2022 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 photo
members documentation

3. Local youth development plan Approved LYDP with LYDC Resolution approving the
LYDP
CDP/PDPFP

If LGU has no approved LYDP:

LYDC Certification that final draft of LYDP is
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) in
CY 2022

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

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32
 Department of the Interior and Local Government
CY 2023 Seal of Good Local Governance

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Prepared by: Certifying completeness of documentary submission:

(Name and Signature) (Name and Signature)

DILG Field Officer DILG Cluster Head/LGPMS-SGLG RFP

Date signed: _____________________________ Date signed: ______________________________

33