PANG-AGRARYONG TULAY PARA SA BAGONG BAYANIHAN NG

MGA MAGSASAKA
(PBBM BRIDGES)

INITIAL VALIDATION FORM

TECHNICAL SURVEY* Form No.

PROFILE Date filled-up

1 BRIDGE NAME M M D D Y Y Y Y

2 PROPOSED LENGTH in linear meter Name of Contact Person/Field Validator

3 REGION
Office / Designation
4 PROVINCE

5 CONG. DISTRICT
Contact Number & Email Address
6 CITY / MUNICIPALITY

7 INCOME CLASS

8 BARANGAY 1

9 BARANGAY 2 Signature over printed name

ACTUAL SITE DATA L = Pre-filled

"A" "W" "B"

NAME OF RIVER/WATERWAY

WIDTH OF RIVER (W) . m DEPTH OF RIVER (W) . m

COORDINATES @ POINT "A" COORDINATES @ POINT "B"

N ° ' . '' N ° ' . ''
E ° ' . '' E ° ' . ''

ELEVATION @ POINT "A" (MASL) ELEVATION @ POINT "B" (MASL)

. m . m

SOIL TYPE @ POINT "A" SOIL TYPE @ POINT "B"

Sandy Clay Rocky Sandy Clay Rocky
Silt Loamy (Combination) Boulders Silt Loamy (Combination) Boulders

FLOOD RISK FLOOD LEVEL FLOOD RISK FLOOD LEVEL

YES m YES m
NO NO

VEGETATION VEGETATION HT. VEGETATION VEGETATION HT.

YES m YES m
NO NO

ROAD WIDTH @ POINT "A" ROAD WIDTH @ POINT "B"

. m . m

ROAD CONDITION @ POINT "A" ROAD CONDITION @ POINT "B"

NO ROAD Gravel Surface NO ROAD Gravel Surface
Rough Paved Rough Paved

*To be filled-up by the Municiupal Engineer or equivalent

Page 2 of Technical Data Form
SITE PHOTOGRAPHS
Va
VA

"A" "B"

Photos from VA (Approach) Photos from Va

Vb
VB

"A" "B"

Photos from VB (Approach) Photos from Vb

ENVIRONMENT-RELATED DATA Additional Requirements

1 Is this a replacement of existing bridge? Please provide a Location map (with

(If YES, proceed to next question) YES NO electronic copy) showing bridge location
linked to the road networks

2 Is the bridge passable during rainy season?

YES NO
3 Is the project site within or very near a
National Park and/or protected area? YES NO

4 Is the project site within an indigenous

people's (IP) community? YES NO

5 Is there any quarrying activity within the area?

YES NO
6 Is the project site accessible to a 40-footer
van /delivery truck? YES NO

Page 3 of Technical Data Form

Page 3 of Technical Data Form
FOR RESETTLEMENT ACTION PLANNING
 "Approach A" "Approach B"

Estimated length of 'Approach A' Estimated length of 'Approach B'

(in LM) (In LM)

Are there households currently living within YES NO Are there households currently living within the YES NO
the construction site of Approach A? construction site of Approach A?
(within 5 meters from the center of the road aproach for barangay (within 5 meters from the center of the road aproach for barangay
roads) roads)

Actual number of affected households Actual number of affected households

Type of land ownership private owned Type of land ownership private owned
government property government property

Please provide photograph 'Approach A' construction site Please provide photograph 'Approach B' construction site
 PANG-AGRARYONG TULAY PARA SA BAGONG
BAYANIHAN NG MGA MAGSASAKA
(PBBM BRIDGES)

INITIAL VALIDATION FORM

SOCIO-ECONOMIC SURVEY*
Form No.
PROFILE
Date filled-up
1 BRIDGE NAME
M M D D Y Y Y Y
2 PROPOSED LENGTH in linear meter
Name of Contact Person/Field Validator
3 REGION

4 PROVINCE Office / Designation

5 CONG. DISTRICT
Contact Number
6 CITY / MUNICIPALITY

7 INCOME CLASS Email Address

8 BARANGAY 1

9 BARANGAY 2 Signature over printed name

DEMOGRAPHICS

1 List the INFLUENCE BARANGAYS (e.g. Barangays that are 2 Is the bridge within an AGRARIAN
within the 5 km radius from the bridge including host barangay) REFORM COMMUNITY/ARC CLUSTER YES NO
or link to the ARCs?

If YES, please specify name of the ARCs/ARC Clusters

3 Is the project site within an Indigenous YES NO

Peoples (IP) community?

4 Total Population in the INFLUENCE 5 Total Number of Agrarian Reform

BARANGAYS Beneficiaries

Number of WOMEN Number of women ARBs

Number of IP Number of IP ARBs

6 Annual Population Growth Rate of the Municipality

5 Is the LGU willing to provide counterpart for the implementation of the bridge?
Implementation of the Resettlement Action Plan YES NO
Operations and Maintenance fund years
*To be administered by DAR Officer with the Municipal Development and Planning Officer (MPDO)

…page 2 of Socio-economic Data Form

USAGE AND TIME OF TRAVEL FROM AREA SERVICED BY THE BRIDGE TO POBLACION

Number trips per week Length of Time from Bridge Distance from ARC to the Transportation Cost
using the bridge to Poblacion (in minutes) Market/Poblacion
TYPE OF VEHICLE
Before new After new Before new After new Before new After new Before new Unit After new
bridge bridge bridge bridge bridge bridge bridge bridge
per person
Motorcycle per trip

per person
Tricycle per trip
Handtractors With
per kilo per
Trailers/ tracks/hauling trip
tracks
per person
Public jeepney/bus/van per trip

gas exp. per

Private cars/jeep/van trip

Others, please specify

(i.e. bangka, animal
trasport, etc.)

per kilo per

trip

NUMBER OF PEOPLE CROSSING/USING THE BRIDGE PER WEEK

USERS OF THE BRIDGE Before After Daily Wage Rate
New Bridge New Bridge
SKILLED WORKERS (e.g. veterinarian, agriculturist, driver, farm machine operators,
mason, carpenter, plumber, electrician, etc.)
> Number of SKILLED WOMEN WORKERS
UNSKILLED WORKERS (e.g. landless farm laborers, construction workers)
> Number of UNSKILLED WOMEN WORKERS
OTHER PEOPLE
> Number of WOMEN

MAJOR CROPS PLANTED/ECONOMIC ACTIVITIES IN THE INFLUENCE AREAS

Area Planted Annual Yield % of Total Volume of

NAME OF MAJOR CROPS (in Hectares) per Hectare Production Hauled to the
(e.g. palay, corn, pinapple, banana, Check if (in kilograms) Market
vegetables, etc. New Crop
Before new After new Before new After new Before new After new
bridge bridge bridge bridge bridge bridge
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