FINAL Editable Documentary Checklist SGLG 2024

Department of the Interior and Local Government Form 2.
1
Financial Administration
CY 2024 Seal of Good Local Governance
Seal of Good Local Governance – DOCUMENTARY CHECKLIST

Form 2.1 Financial Administration
City/Municipality of : PEÑABLANCA Income Class : 1st

Province : Cagayan Region : 02
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 2022 Annual Audit Report by the
Commission on Audit
☐LGU’s CY 2023 Annual Audit Report by the
Commission on Audit
2. Compliance with the Full Disclosure Policy for CY ☐Form 2E: Photo Documentation
2023 2nd to 4th quarters and CY 2024 1st quarter,
posting in 3 conspicuous places and FDP portal
3. d (SGLG-IF), if applicable ☐DILG RO letter approving LGU’s request for
extension
☐Proof of date of LGU’s date of receipt of NTI from
the DILG RO
☐Receipt/Deposit Slip of Reversion of Subsidy to
National Treasury
4. Project completion of all FY 2022 Local Government ☐Copy of Notice of Authority to Debit Account Issued
Support Fund (LGSF) project, if applicable (NADAI) funded under FY 2022 LGSF
☐Receipt/Deposit Slip of Reversion of Subsidy to
National Treasury, for unimplemented projects
☐Program of Works, if necessary
5. Approved CY 2024 annual budget ☐Appropriations ordinance enacting and approving
the LGU’s CY 2024 annual budget
Other Supporting Documents (to be supplied only if the listed documents are NOT yet available)
Prepared by: Certifying completeness of documentary submission:

1
Department of the Interior and Local Government
AGATHA MAILLANI L. CASTILLO LUIS E. UDANGA

DILG Field Officer DILG Cluster Head/LGPMS-SGLG RFP
(Name and Signature) (Name and Signature)
Date signed: Date signed:
2
Department of the Interior and Local Government Form 2.2
CY 2024 Seal of Good Local Governance Disaster Preparedness

Form 2.2 Disaster Preparedness

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 2023
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
2b. Plantilla LDRRMO Staff ☐Appointment of LDRRMO staff with CSC attestation
accredited
requesting attestation of appointment, in case LGU is not
accredited
☐Executive order/ similar issuance for designation of
LDRRMO staff
2c. LDRRMO Workspace ☐Form 2E: Photo Documentation
2d. Equipped and trained Search and Rescue ☐List of organized teams and personnel
3

(SAR) or Emergency Response (ER) teams complement
☐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
☐Form 2E: Photo Documentation
3. Approved PDPFP or CLUP For PDPFP:
☐DHSUD/HLURB copy of resolution approving the
PDPFP covering CY 2022/2023/2024
☐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
☐Sanggunian resolution adopting LDRRM Plan
☐LDRRMC Resolution approving the LDRRM Plan
☐Approved 2023 and/or 2024 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)
☐Proof of transmittal of LCCAP to CCC
If LCCAP is integrated:
☐Approved CLUP/CDP
4

☐Sanggunian resolution adopting CLUP/CDP
☐Approved CY 2024/2023 AIP with CCET

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. Disbursement rate of the LDRRMF’s 70% Disaster ☐Certified Form 2A (Accounting Office)
Preparedness and Mitigation component ☐Certified Form 2F (LDRRMO)
8. Early warning system ☐Photo documentation of EWS (Certified Form 2E –
Photo Documentation)
☐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
10.a. Evacuation Center ☐List of evacuation centers
☐MOA/MOU (covering CY 2023 or 2024) with
partner-schools or child development centers
☐Photo documentation of EC (Certified Form 2E –
Photo Documentation)
☐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. 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 2023 or 2024) 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
5

services (with photos)
☐Certified Form 2E – Photo Documentation
10.c. 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)
11. LDRRM Operations Center ☐EO or similar issuance on the establishment of
LDRRM OpCen in case it is temporary or functions 24/7
☐OpCen Employee logbook
☐SOP/OpCen manuals
☐Certified Form 2E – Photo Documentation
12. 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
13. CBDRRM Plans [for cities and municipalities only] ☐Certified Form 2F (LDRRMO)
☐One (1) Sample CBDRRM Plan with corresponding
BDC resolution
☐Approved 2024 Annual Investment Program
14. Participation in and compliance with the submission ☐Certificate of GK Participation, if available
of required documents in 2024 Gawad Kalasag (GK)
Seal for LDRRMCs/LDRRMOs
6

7
CY 2024 Seal of Good Local Governance Social Protection

Form 2.3 Social Protection and Sensitivity

1. CY 2023 Seal of Child-friendly Local Governance ☐Copy of Certificate from DSWD and DILG for 2023
[for cities and municipalities only] Seal of 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 (for cities
and municipalities)
☐Printed / electronic /online GAD database or
information management system that can generate
gender statistics, and sex-disaggregated data
☐CY 2023 and 2024 GAD Plan and Budget
☐CY 2023 GAD Accomplishment Report
☐Certification on GAD Plans Submission (Certified
Form 2E DILG Field Office)
☐GAD Funds Disbursement Data (Certified Form 2A
Accounting Office)
☐Report on CY 2023 GAD Plan’s PPAs completion
(Certified Form 2H Planning and Development Office)
3. Mechanisms for Anti-Trafficking and VAWC ☐EO or similar issuance organizing LCAT-VAWC
☐Minutes of the LCAT-VAWC meetings in CY 2023
☐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
5. Accessibility for Persons with Disabilities and Older ☐Form 2G: Photo Documentation and Information
Persons (Engineering Office)
☐Form 2E: Photo Documentation of DILG Field 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
8

next 2 years for the primary health facility
☐Copy of CDP/PDPFP, LIPH, LDIP, AIP, or annual
budget with the proposed PAPs for the primary health
facility
6. Functionality of Persons with Disability Office ☐Ordinance/EO creating PDAO
(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 2023 accomplishment report
☐PDAO Citizen’s Charter indicating mechanism for the
issuance of persons with disability ID
7. Sign language interpreter in every LGU [for ☐Appointment paper of sign language interpreter
provinces and cities only] ☐Executive Order or similar issuance appointing sign
language interpreter
☐Documents as proof of hiring sign language interpreter
(e.g. contract of service, etc.)
☐Proof of engagement with external service provider
(e.g. MOU etc.)
☐LDIP, AIP, or annual budget
☐Certificate of Training(s) attended relative to sign
language
8. Established Senior Citizens Center [for cities and ☐MOA between LGU and partner organization
municipalities only] managing the facility
9. Indigenous Peoples Mandatory Representation in ☐Certificate of Affirmation received by IPMR
the Sanggunian, if applicable ☐Copy of at least one payroll for CY 2024
☐Minutes of the Meetings for CY 2024
☐NCIP-RO Hold-over resolution, if the case may be
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 2023 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. Disbursement of funds for the marginalized ☐Certified Form 2A (Accounting Office) (Report on
sectors: funds disbursed 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 care facility for ☐Accreditation of the facility issued by DSWD-
the vulnerable sectors [for provinces and cities only] Standards Bureau or BARMM MSSD
☐Form 2E – Photo Documentation
9

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 Certificate of Accreditation if LGU is not

listed in NGA data
13. Support to/Adoption of 4Ps ☐LGU Monitoring Tool
☐Copy of ordinance, CDP, LDIP, AIP, or LPRAP, or
2023/2024 annual budget indicating allocation for 4Ps
☐Sustainability Plan or C/MAP, or Local Transition Plan
14. 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)
☐CBMS 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
15. LGU Efforts on mainstreaming social protection ☐Social Protection Development Report developed in
CY 2019 onwards
☐Social Development Plan integrated in local plans
certified by the local planning officer
☐Ordinance or similar issuance on any area of
recommendation of the SPDR
☐Copy of endorsement letter duly received by the
PSWDO
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
10

names of member-CSOs and official representatives)
☐LDC Minutes of the Meetings for CY 2023
☐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 ☐ Executive Order or Resolution creating the LDC (with
organizations (CSOs) in LDC names of member-CSOs and official representatives
☐List of organized and accredited CSOs
☐LDC Minutes of Meetings in CY 2023
☐CSO Plan of Action, if any
☐ Documentation of workshops on project prioritization
conducted in CY 2023, if any
☐Post-activity report, if any
☐Project monitoring report, if any
17. Establishment of Population Office with appointed ☐Certified Form 2E (Photo documentation)
or 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
based) [for cities and municipalities only] and establishment of a Teen Center
● ☐Certified Form 2E (Photo documentation)

11
CY 2024 Seal of Good Local Governance Health Compliance and
Responsiveness

Form 2.4 Health Compliance and Responsiveness

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)

(in case local data differ from NGA data due to clerical
errors only)
1. Complete Local Investment Plan for Health (LIPH)
2. 62.5% of households using safely managed
drinking-water services
3. At least 53% of Households using safely managed
sanitation services
4. At least 10% increase from previous year’s
performance result for TB Case Notification Rate
5. More than or equal to 90% TB Treatment Success
Rate
6. At least 60-110% OPT Plus coverage and stunting
prevalence within the medium level of public health
significance
7. At least 95% fully-immunized child coverage
8. At least 95% of pregnant women with at least 4
prenatal check-ups in CY 2022
9. Functional Local Health Board
10. At least 8% of adults 20 years old and above who
were risk assessed using the PhilPEN protocol in
CY 2022
11. Presence of accredited Konsulta Providers (for
cities and municipalities only)
12. Institutionalized DRRM-H System with the
presence of all four DRRM-H components
13. Functional Epidemiology and Surveillance Unit
(ESU) with all ESU components present
12

13
CY 2024 Seal of Good Local Governance Sustainable Education

Form 2.5 Sustainable Education


1. Functional local school board
1a Composition ☐EO or similar issuance creating the LSB

1b Meetings ☐Minutes of the Meeting of LSB in CY 2023
☐Certified Form 2D accomplished by Schools Division
Superintendent or the District Supervisor (DepEd)
2. At least 60% disbursement rate on education, ☐Certified Form 2D accomplished by Schools Division
culture, and sports/manpower development Superintendent or the District Supervisor (DepEd)
expenditure from the Special Education Fund
(SEF) for FY 2023
3. Conduct of PAPs in CY 2023 that promote ☐Accomplishment Report from the LGU
inclusive education ☐DepEd reports on program implementation review and
other data from concerned DepEd Central, Regional and
Division Offices
4. Early Childhood Care and Development ☐Form 2J – LSWDO
5. Technical-Vocational Education and Training ☐Certification from TESDA that the LGU has conducted
(TVET) community-based technical education and skills
development training
☐CDP, LDIP, AIP, or Annual Budget
☐Post-activity reports
Certifying completeness of documentary submission:

Prepared by:
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15
CY 2024 Seal of Good Local Governance Business-Friendliness and
Competitiveness

Form 2.6 Business-friendliness and Competitiveness


1a. Finalist of the PCCI's Most Business-Friendly LGUs ☐Copy of Recognition received from PCCI
Award
1b. Ranked among the Top 20 Provinces/ Cities/ ☐Copy of Recognition received from DTI-CB
Municipalities in the CY 2023 Competitiveness Index
2. Presence of local economic development and ☐Ordinance creating LEDIP Office/Unit
investment 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 ☐Form 2E: Photo Documentation
new 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] ☐Photo Documentation of BOSS (Form 2E: Photo
Documentation
☐Citizen’s Charter
☐Sample transactions for renewal and new
businesses for 2023
☐Ordinance on the integration of barangay clearance
to the business permitting process.
☐Barangay resolution authorizing the City/Municipal
Treasurer to collect fees for Barangay Clearance for
Business permit and locational clearance purposes
issued within 2020 to 2024
☐Sample order of payment and official receipt
reflecting barangay clearance fees
☐Memorandum of Agreement or any document that
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 ☐Ordinance adopting the LIIC
cities only] ☐Ordinance amending/ revising particular section(s)
16
of existing LIIC
☐PPP Code/JV Code/PEZA Code (as
applicable)
LUIS E. UDANGA
AGATHA MAILLANI L. CASTILLO
Form 2.7
Safety, Peace and Order
17
Form 2.7 Safety, Peace and Order


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 ☐List of barangays with organized BPATs, barangay
municipalities only] 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

Form 2.8
Environmental Management

Form 2.8 Environmental Management
18
PEÑAB Income Class : 1st

LANCA
City/Municipality of :

1. Convened local solid waste management board ☐Copy of Executive Order or similar issuance creating
the SWM Board
☐Minutes of the meeting in CY 2023
☐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 ☐Approved Safe Closure and Rehabilitation Plan
[for cities and municipalities only] ☐EMB-RO Acknowledgement Letter for SCRP
☐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)
☐Certified Form 2M (Local ENRO)
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:

☐Receiving copy of LGU’s letter submitting its Plan for
NSWMC’s review
4. Functional Materials Recovery Facility [for cities ☐Form 2E: Photo Documentation
and municipalities 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 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 ☐Certified Form 2M (Local ENRO)
collection of wastes [for cities and municipalities ☐Photo documentation of actual temporary Residual
only] Containment Area, SLF, WTE, and other facilities
(Certified Form 2E – Photo Documentation)
☐Memorandum of Agreement
☐Project progress report(s)
☐Approved SWM Plan
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☐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)
☐Proof of registration/ECC with permits with DOE if the
WTE facility is not included in the list
6. Initiatives contributing to biodiversity conservation ☐Ordinance establishing wetland/s or water body as
and enhancement focusing on inland wetlands and conservation area or with protection purposes
water 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
☐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
☐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)
☐Site profile and assessment of public parks and green
spaces
☐Ordinance supporting the establishment and
maintenance of a public park/green open space
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☐Accomplishment Report of Program or project

conducted for public parks and green spaces

21
CY 2024 Seal of Good Local Governance Tourism, Heritage
Development, Culture and
the Arts

Form 2.9 Tourism, Heritage Development, Culture and the Arts


1. Tourism Development
1.1. Presence of a local tourism officer ☐Appointment of local tourism officer with CSC
attestation
☐Executive order designating an officer for tourism
development and promotion with listed functions,
duties, and responsibilities
1.2. Tourist information and assistance center or ☐Form 2E: Photo Documentation (DILG Field Office)
desks ☐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
☐Copy of draft Local Tourism Development Plan
1.4. Submission of Annual Supply and Demand ☐Annual Supply Tourism Statistics Report for CY
Tourism Statistics Report 2023
☐Copy of transmittal of Annual Supply Tourism
Statistics Report for CY 2023
☐Supply Database for Accommodation
Establishments (SAE1)
☐Supply Database for Tourist Attractions (STA)
☐Supply Database for other Tourism Enterprises
(STE)
☐Annual Demand Tourism Statistics Report for CY
2023
☐Copy of transmittal of Annual Demand Tourism
Statistics Report for CY 2023
☐Demand Database for Accommodation
Establishments (DAE3B, DAE3B.2 and DAE3)
☐Demand Database for Tourist Attractions (DTA)
☐Demand Database for MICE Facilities (CUS)
☐Certification from DOT Regional Office certifying the
submission of provinces, cities, and municipalities of
their respective reports using the standard template
2. Cultural Heritage Promotion and Conservation
2.1. Presence of a Local Culture and Arts Council ☐Copy of Local Ordinance or Sanggunian resolution
or a similar issuance creating an LCAC with functions,
duties, and responsibilities
2.2. Disbursement of the budget appropriated for the ☐CY 2023 Annual Appropriations Ordinance
22
conservation and preservation of cultural indicating budget for the conservation of tangible
property, CY 2023 cultural property or safeguarding of intangible cultural
property, including cultural mapping; and
☐Disbursement Data per Certified Form 2A
Accounting Office
2.3. Presence of an updated Cultural property ☐Updated Local Cultural inventory using the updated
inventory/registry in the LGU templates prescribed under DILG-NCCA JMC No.
2021-001
☐Proof of transmittal of the inventory to the NCCA
☐Sanggunian Resolution adopting the inventory
☐ Valid Certificate of Compliance issued by the NCCA
2.4. Published narrative of history and culture ☐Copy of published narrative of history and culture
☐Ordinance, Sanggunian resolution, executive order,
or other similar issuance indicating LGU
acknowledgment of the published narrative

Date signed: Date signed: Form 2.10

Youth Development

Form 2.10 Youth Development

23

1. Functional youth development council
1.1. Composition ☐Executive order or similar issuance creating the
LYDC
☐Copy of YORP Certificates / Organizational Profile of
Registration of the Organization (LYDO)
1.2. Meetings ☐Official written notice and LYDC Approved Minutes of
the Quarterly Meetings in CY 2023
☐One agenda reflecting a discussion on the monitoring
or development of LYDP
☐Approved attendance sheet
1.3. Training ☐Training Certificates
☐Post-Activity Report / Highlights of the training with
photo documentation
☐List of existing LYDC members
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:

accredited
requesting attestation of appointment, in case LGU is
not accredited
For designated LYDOs:
☐Certification from Budget Officer indicating that the

LGU has met the PS limitation (Form 2C – Budget
Officer)
2.2. Database of youth organizations ☐Updated list of youth organizations or youth serving
organizations registered and verified under YORP as
of CY 2023
☐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 75% disbursement rate of appropriated ☐Certified Form 2A (Accounting Office)
CY 2023 budget for youth development ☐CY 2023 Approved Annual Work and Financial
24

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 ☐Post-Activity Report / Highlights of the training with
LYDC members photo documentation
☐Approved attendance sheet
☐Post-activity Evaluation Result (per ARTA’s
Guidelines on Client Satisfaction Measurement)
3. Local youth development plan ☐Approved LYDP with LYDC Resolution approving
the LYDP
☐CDP/PDPFP
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
– Photo Documentation)
☐Other documents demonstrating the creation,
designation, maintenance and/or operation of a
facility/ies devoted to youth development.
4.c. Program for Youth Development ☐Concept Note and Post Activity Report with profile
of the youth-related program or service conducted by
any LGU office (aside from LYDO) in CY 2023
☐Approved CDP/PDPFP or Annual Investment
Program

25

FINAL Editable Documentary Checklist SGLG 2024

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Department of the Interior and Local Government Form 2.

Seal of Good Local Governance – DOCUMENTARY CHECKLIST

City/Municipality of : PEÑABLANCA Income Class : 1st

Prepared by: Certifying completeness of documentary submission:

AGATHA MAILLANI L. CASTILLO LUIS E. UDANGA

Date signed: Date signed:

Seal of Good Local Governance – DOCUMENTARY CHECKLIST

City/Municipality of : PEÑABLANCA Income Class : 1st

For cases with consideration:

Data Available Documents

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

Data Available Documents

☐Approved CY 2024/2023 AIP with CCET

Data Available Documents

Prepared by: Certifying completeness of documentary submission:

AGATHA MAILLANI L. CASTILLO LUIS E. UDANGA

Date signed: Date signed:

Seal of Good Local Governance – DOCUMENTARY CHECKLIST

City/Municipality of : PEÑABLANCA Income Class : 1st

Data Available Documents

Data Available Documents

In case partner-facility is private Social Welfare and

☐Copy of valid Certificate of Accreditation if LGU is not

☐CBMS database or other database/tracking system

Data Available Documents

For Socio-economic plans and policies:

Prepared by: Certifying completeness of documentary submission:

AGATHA MAILLANI L. CASTILLO LUIS E. UDANGA

Date signed: Date signed:

Seal of Good Local Governance – DOCUMENTARY CHECKLIST

City/Municipality of : PEÑABLANCA Income Class : 1st

Data Available Documents

Prepared by: Certifying completeness of documentary submission:

AGATHA MAILLANI L. CASTILLO LUIS E. UDANGA

Date signed: Date signed:

Seal of Good Local Governance – DOCUMENTARY CHECKLIST

City/Municipality of : PEÑABLANCA Income Class : 1st

Data Available Documents

1a Composition ☐EO or similar issuance creating the LSB

Certifying completeness of documentary submission:

AGATHA MAILLANI L. CASTILLO LUIS E. UDANGA

Date signed: Date signed:

Seal of Good Local Governance – DOCUMENTARY CHECKLIST

City/Municipality of : PEÑABLANCA Income Class : 1st

Data Available Documents

Prepared by: Certifying completeness of documentary submission:

Date signed: Date signed:

Seal of Good Local Governance – DOCUMENTARY CHECKLIST

Form 2.7 Safety, Peace and Order

City/Municipality of : PEÑABLANCA Income Class : 1st

Data Available Documents

Prepared by: Certifying completeness of documentary submission:

AGATHA MAILLANI L. CASTILLO LUIS E. UDANGA

Date signed: Date signed:

Seal of Good Local Governance – DOCUMENTARY CHECKLIST

PEÑAB Income Class : 1st

Data Available Documents

In case the plan is still under review of NSWMC:

☐Ordinance for the segregated collection

☐Accomplishment Report of Program or project