No. 1

2

3

4

LGM ED

Document Code

QP-ROS-LGMED-25 Rev. No, Eff. Date Page --IDl'ml ..

LUPON TAGAPAMAYAPA INCENTIVES AWARD ASSESSMENT AND SUBMISSION OF NOMINEE

This procedure begins upon receipt of Memorandum from the Central Office which requires the organization of Award Committees in all levels who will conduct the assessment/evaluation of ent ries and will end upon the submission of the Official Regional Entry to the National Awards Committee.

To provide unified process of implementation and to ensure thequality and acceptability of the zy evaluation of the regional L TIA nominees prior to submission to the national level.

References :-.;·.

Receipt of MC from • Receive and record the Logbook Administrative Office of the Regional MC and route to RFP. Staff/ Records Director Personnel

LGMED/ RFP Prepare RMC w ith • Prepare RMC . DILG MC; RMC timeline and • Disseminate RMC reactivation of RAC. together w ith t he Letters to RAC

updated LT IA m embers Gu ide lines to Provincia l Offices th rough e-mail and mails.

• Invit e & coordinate with members of t he RAC and seek comm itment to the assessment.

PO/ PFP Dissem inate L TIA Receive/open m ail Logbook and Guidelines to and/oremail, Logsheet C/MLGOO. record/ download and

transmit L T IA Guide line to C MLGOOs

PD /C/MLGOOs Organization and • Organize the AC for LTIA in Orientation of Awards Provincial, City and

THIS DOCUrYlENr !S CONTROLLED AND NOT TO BE REPRODUCED WITHOUT AUTHOR[ZATJON

DILG RS QMS

ONTROLLED COPY j l ! -

._ ,

Ste p

No.

Responsible Personnel

PROCESS/ ACTIVITY

Committee (AC)

Rev. No. Eff. Date Page

10-02-17 1 of ::i Details

Municipal level • Orient the members of the

AC

References

For Municipalities and Component Cities Award Committees

5 C/MLGOOs Conduct local assessment and initial evaluat ion.

For Provincial Awards Committee

6 Records Personnel Receive LTIA entries from C/Municipality

• Require the LTs to submit the required documents.

• Check completeness and appropriateness of documentation of each barangay.

• Convene City/Municipal Awards Committee for the initial assessment and conduct validation.

LTIA Form 6 LTIA Form 7

LTIA Form 7-B

LTIA-Form 1 (Basic Performance Evaluation Form)

• Consolidate and submit • LTIA-Form 2 accomplished forms with the necessary documentary requirements of the assessed LTs

• Retain Documented Information

(Consolidated Performance Evaluation Form)

• Accomplish LTIA-Form 3 [C/M) (Comparative Performance Evaluation Form)

• Receive and record the Logbook and LTIA entries logsheet

THIS OOCUYIENT 15 CONTROLLCD ANO NOT 10 6€ R£:PRODUClD WITHOUT AUTHORIZATION

DtLG RS QMS

ONTROLLED COPY t •

"' ' Oo<ument Code

QP-ROS-LGMED-25 Rev. No. Elf. Date

--llml'fl Ste

Responsible p PROCESS/ ACTIVITY Details References No.

Personnel

7 PO/ PF P Conduct local • Require the LTs to submit LTIA Form 6 assessment and initial the required documents. LTIA Form 7 evaluation. LTIA Form 7-B

• Check completeness and appropriateness of documentation of each barangay.

• Convene Provincial Awards LTIA-Form 1

Committee for the initial (Basic

assessment and conduct Performance

validation. Evaluation Form)

• Consolidate and submit • LTIA-Form

accomplished forms with (Consolidated

the necessary documentary Performance

requirements of the Evaluation

provincial top LT per award Form)

category • Accomplish LTIA-Form

• Retain Documented [C/M)

Information (Comparative Performance Evaluation Form)

For Regional Awards Committee

8 Record Receive and record • Receive and record Logbook and Officer/LG MED logsheet

9 RFP Convene RAC • Invitation of the awards committee

10 LGMED/RF P Conduct initial LTIA Form 6 assessment • Check the completeness LTIA Form 7

and appropriateness of LTIA Form 7-B

documentation of each entry per category.

• Convene Regional Awards Committee for the initial assessment LTIA-Form 1

(Basic Performance Evaluation Form)

THIS DOCUMENT IS CONIROlLED AND NOT TO OE R!:'.PROOUCED WITHOUT AUTHORIZATION

DILG RS QMS

ONTROLLED COPY l ,.__,.rr':._~lWW•#H ......_.

2

3

'Ste :/A'_<, '''"· .•, ' ·;{ '

Responsible '"7 < , ,:

l<i PRO~~Sj ACTIVJTY p . Personnel

No . . \;-,· t ,

11 Conduct site evaluation

12 Final evaluation

13 RFP Submission of LTIA-Form 5 (Official Entry Form)

14 Concerned Division/ Retain of Records Regional/

Provincial SGLG

Definition of Terms:

• L TIA- Lupong Tagapamayapa Incentives Awards Legal References:

• M.C. No. 2016-58

Prepared By

Prepared B-;.

Document Code

QP-ROS-LGMED-25 Rev. No. Eff. Date Page

10-02-17 lofTI ; ~if;. -· ·;,

:~

Detan~· 1·, " Rlferences ., '4[_ .,,., _:;; - .ii ; ., '·. ,

'< .. ,, , , ,.

• LTIA-Form 2 (Consolidated Performance Evaluation Form)

• Accomplish LTIA-Form 3 [C/M] (Comparative Performance Evaluation Form)

• Conduct On-sit e validation & evaluation

• Accomplish forms of the LTIA Form 5 Official Regional entries per award category

• Submit accomplished forms Logbook and with the necessary logsheet documentary requirements of the Official Regional LTIA Form 5 entries per award category in a single PDF File Format thru google drive at the L TIA National Secretariat

• Retain Documented Information

Retain records File copy of L TIA results

Reviewed By Approved By

- OLI O D. RAMIREZ L MED Chief

ATTY R L E:E R ., ESO V Assistant Regional Director

-1, Process ()wner '':' Divj$1on «;lllef/Next Higher Supervisor Regionaf QMR

Ttt!S DOCUMENT IS CONTROLLED AND NOT TO BE RE.PRODUCED WITHOUT AUTHORIZATION

·- , .

Republk ol tho PNMpplnos ® DEPARTMENTOFTHE INTERlORANDLOCALGOVERNMENl REGIONAl OF ACE

OHICI Loa I Governm.-nt Morwtorq and f'ntuatlon Ofvldon jl..GMtD)

PROCISl Monitorlnc•ftd EnbtUon oflGUCafllPUniceto LocalGovtnMn« ,Olide!

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Committees -Completeness cl.enlJ

and •ccuracy Lackln1 w pportina NOIHY"l1biJity of of entries documents of submitted ........... s ubm itted by entrle1 t.itl\MOl'ies

the provlncu

mmt!l'r l"ON~...,1tt1billtv of tM NM-aniW,ity of

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!comm- doc.vments to be Wbmltted1ttht'

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t heOffirialLTIA th• fo(',11 P«sons to NlftMntMIYH

Regk>n,1 Entries chedl 1nd vatid1te ~ the offlcttt0i1Ct1IM

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OfFICE/UNIT,IJ'!!"'<d'-- - - ------- - - ------- - - ------------------~---------------------------------------PROCWURE: t.upan Taca.pamay.ipl IJKendveiAwanls A,ses,ment and SubminJoa of Nominee

raocmm• (9awdontlte I'<

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DILG · REGION V (BICOL REGION) QO·QP·ROS·LGMED·25 ruo;m,;11111M1

Conduct of Assessment& Yalidation and Submission of Entries to the National Seccetaciast fBLGS) Summary Loesheet (PSL) 1•t" I ~ot!I 1:- ·1 QUALITY OBIECTIVE: FREQUENCY OF MONITORING COVERED PERIOD: Due Date of Submission: IAC•nd:

Date Received For dlssemlnaUon/C

oordlnatJon One (1) week

Yearly

january to Maret 30-Mar

Timeliness

Assessment and ValldaUon

Asses.sme!nt Conduct of On• Reactivation/ 0 Period Site ValldatJon

rganization Two (2) One (1) month On• (I} week weeks

N:.."IT"~e-•w•a, I

DILG RS QMS

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Objectlve Results: (Date Rtttlv<d w Dai, coo11wanJ01tNI to requHt.lnc LCU deffclency or lackfn&

docwnaenll vs. dal~ l•dc.Jn1 documents or data Completeness ofSupporl1ng Documents ttttfwd vs Date on~sltt waiilklaUon 11 cc:,nducted vs Remarks/ Particulars

Oat~ l ndorwm~nl or Cenlncauon rorwarded to PD or RD ror sl1nature vs Required documents rorwar ded 10

PO/R0/8LCS(N11lonal Sccretarlat)

No Yes

Date Date Date Lacking lndorsed/ forward com.municated to documents or data

ed to LGUconcerned rece ived BLGS/Nal1onal lacking documents

Met Unmet Rertlark.s. If unmet Secretariat I 1st

week of the succedln,i month)

~•Mi'iui4,i@, QO-QP-ROS-LGMED-25

(QO) ~ a:m 10.02.11 r:;1n

OFFICE LGMED

QUALITY PROCEDURE LUPON TAGAPAMAYAPA INCENTIVES AWARD ASSESSMENT AND SUBMISSION OF NOMINEE

TITLE

-., . I ..

Key Performance Indicators (KPI) I~ ... -,.. . ~ ,· Applicable • 1" -

~ I' rr• \.-" • ti; ·, ••~ F"!' n

. Documtrits ~ ";~c ', J (.] ;.-:.} Frequency of Res pons I bl § . . .. (ProceduresJ and ,,

Function ., .. ,J Monitoring efor

Obj~ctiY•f' • I • ...!., i=, lndlcator/F ormufa Fonns (~ecords),

' Target (if applicable) . Res:';'fts M9nltorlng : including applicable ,,:r

" '"-·· . , ) I!

'~. '-' J',, ,. ·-. Laoal Reaulrements

• Timely • 75% • Within 10 days upon receipt of the • Once • LGMED- • RMC LUPON dissimination LTIA Guidelines the draft RMC with RFP TAGAPAMAYAPA of guidelines proposed timelines of activities is • PFP INCENTIVES and timelines approved and dissiminated to AWARD to all levels provincial and municipal offices. ASSESSMENT AND (provincial and SUBMISSION OF municipal NOMINEE offices)

• Timely • . 90% • (The number of Awards Committee • Once • RFP • Regional Order organization that were organi.zed and oriented • PFP • E.O. creating the and within 10 working days upon receipt of • C/MLGOO Awards Committee orientation of the Regional Order I Total number of s • Minutes of the the Awards Awards Committee organized and Meeting Committees oriented.) X 100 • Terminal Reports of

the Orientation

• Completeness • 90% • (The number of LT with submitted • Once • C/MLGOO • Nomination forms and accuracy documents unreturned for its s indicated in the of entries completeness of documents/error-free Checklist (municipal submitted by data entry / The total number of LT level) the province assessed) X 100

• • • • • •

DILG RS QMS THIS DOCUMENT IS CONTROLLED AND NOT TO BE REPRODUCED WITHOUT AUTHORIZATION

,,;~~J:R~~~~~__J

,. -

l·i·i9111ti411Mt= I QO-QP-ROS-LGMED-25

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-_, ·. ,. ~ :·. Key Perfonnance Indicators (KPI) . -; '" ~ ~ Applicable

. i1J "' . F f R lbl Documents . · · _ , requency o npons (P ed ) d ·"'" roe ures an Function .. . ,: ~ ,.,-,.-~;.'' lndicator/Fonnula ,, Monitoring efor .

,. Objective ' ,., ~ Target . _;J; .· , . (if II bl ) Results Monitoring . Fonms (Reco~s), , ~ _ , . , • ~ , . •· app ca • , including applicable -~-' ~ ,'=T•-~~ · :, r ~'f _ . .,. • L&aal Ranulrements

• Timely • 75% • (The number of Official L TIA Regional • Once • RFP • Nomination forms submission of Entries submitted to the National indicated in the the Official Awards Committee within the set Checklist L TIA Regional deadline / The number of Official L TIA Entries to the Regional Entries submitted to the National National Awards Committee} X 100 Awards Committee

• Completeness • 75% • (The number of L TIA nominations • Once • RFP • Nomination forms and accuracy found with complete documents/error- indicated in the of the Official free in data entry I The total number Checklist L TIA Regional of L TIA nominations submitted } X Entries to the 100 National Awards Committee

Division O,lef/Next Deputy QMR Regional QMR

.-::r DILG RS QMS '7 :ONTROLLED COPY ~

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THIS DOCUMENT IS CONTROLLED AND NOT TO BE REPRODUCED WITHOUT AUTHORIZATION

.,

/;----:-:)'"':,,_ DILG - REGION V (BICOL REGION)

(ff or!G -~ PROCESS QUALITY MONITORING AND ~ : .:.~ EVALUATION (QME)

OFFICE LGMED PROCEDURE TITLE LUPON TAGAPAMAYAPA INCENTIVES AWARD ASSESSMENT AND SUBMISSION OF NOMINEE

r a :~1;·~~,5-LGMED-25

~- g:m _10.02.11 ~t,

1: • Timely dissemination of guidelines with timelines to all levels (provincial and municipal offices) 2:0rganization and Orientation

OBJECTIVE STATEMENT of the Awards Committee; 3: Timely organization and orientation of the Awards Committees; 4 Completeness and accuracy of LT/ mun submitted documents: 5:Completeness and accuracy of L TIA nominations at the provincial and regional level; 6: Timely submission of the Official L TIA Regional Entries to the National Awards Committee; 7: Completeness and accuracy of the Official L TIA Regional Entries to the National Awards Committee

CURRENT PERIO.D 201€

INDICATORS

Within 10 days upon receipt of the L TIA Guidelines the draft RMC with proposed timelines of activities is approved and disseminated to provincial and municipal offices.

B I Within 10 days C I Period scaling table

:1 Odays=75% 75%

D I Gap Analysis: (In case the objective is not met, put •our analysis why it is not met

M/C LGU

Objective 2: Organization and Orientation of the Awards.Committee

A I The number of Awards Committee that were organized a'1d oriented upon receipt of the Regional Order . -·

B I Total number of Awards Committee C !·Formula: (A/8)*1O0

Target Result : 90%

D I Gap A.!'alysi~: (In ~~ the objective is ,not met, put ►ur analysis' why it is not me1

t

PLGU

Objective-3: Timely organization and orientation of the Awards Committees A The number:of Awards Committee thatWere -

organized and oriented within 10 working days upon _ receipt of the Regional _ Order

B I' Total number of Awards Committee organized and oriented .

:..1. ,

DIL_G RS QMS THIS DOCUMENT IS CONTROLLED AND NOTTO BE PRODUCED W ITHOUT AUTHORIZAT!OI\

• ~~~~~~.~~~2,_~0P'(_J

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DILG - REGION V (BICOL REGION)

PROCESS QUALITY MONITORING AND EVALUATION (QME)

~cii;~js·b~'fci"s-LGMED-25 I

C L Formula: (NB)*100 Target Result : 90%

D I Gap Analysis: (In case the objective is not met, put ·our analysis why it is not met

Rev. No. Elf. Oat

I oo I 10.02.11

Objective 3: Completeness and accuracy of L TIA nominations. at the provincial and regional level A I The number of L TIA nominations returned due to · I I I ·

I -·~ to· " • .,

1 JI ~- '.' .• :::- ~ .- •

incompleteness of documents/error of data ent, B I The total number of L TIA nominations submitte(j

-C I Formula: (A/8)*100

Target Result : 90%

~ 2 of,

~ -Gap Analysis: (In case the objective is not met, put our anal sis wh it is not met

l•le][AAIH¥i

I "' I .,1 .· I ., . :· -J iii , • --~~ I " .,., . .. ~ t! "-

Completeness and accuracy of LT/ mun submitted documents The number of LT with ,submitted documents unreturned for its completeness of documents/error-free data en ·

B I The total number of LT assessed " C I Formula: (A/8)*1O0

Target Result : 90%

D I Gap Analysis: (In case the objective is not met, put ►Ur analysis why it is not met

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0 · ctive 5: Timel submission of the Official L TIA Re ional Entries fo the National Awards Committee nal Awards Committee -· I A The number of Official L TIA Regional Entries

submitted to the National Awards Committee within

"7 r · , : , I the set deadline

B I The number of Official L TIA Regional Entries submitted to the National Awards G_<>rn_rnittee

C I Formula: (A/B)*100 Target Result : 75%

D I Gap Analysis: (In case the objective is not met, put ►ur analysis why it is not met

'

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~ -. .. ,~~h- ~ . ~ , .1t•f, --~

C. ~~?, t, ~ t'? e National Awards Committee Objective 5: Completeness and accuracy of the Official L TIA Regional Entries to the National Awards Committee

Al The number of LTIA nominations found with I I -1

H incomplete documenJs/error in _data e B"I The total number of LTIA nominations submitted ct Formula: (NB)*100 I Target Result : 75%

DILG RS QMS

:ONTROLLEO COPY ~ ....... ~ --~¥Ht.4NtWPr'¥ ,..,,.,...#

THIS DOCUMENT 1S CONTROLLED AND NOT TO BE PRODUCED WITHOUT AUTHORIZATION

~

(

1

DILG - REGION V (BICOL REGION)

PROCESS QUALITY MONITORING AND EVALUATION (QME)

D I Gap Analysis: (In case the objective is not met, pul ,our analysis why it is not met

,

r,•i·h'i11h•iloffl!i, QME-QP-R05-LGMED-25 i

~ a:m _!Q,_02_17 t:t;it,

Note: For unmet targets of two (2) consecutive periods, concerned Deputy QMR initiate correction and corrective action using the Corrective Action RePOrt (CAR) and attach It to this fonn.

Process Owner

DILG RS QMS

:o~TR~~.£._£OPY_J

Division ChieflNext Higher Supervisor

ATTY. A~ALDO E. ESCOB'i'R JR., CESO \I Assistant Regional Director

Regional QMR

THIS DOCUMENT IS CONTROLLED AND NOT TO BE PRODUCED WITHOUT AUTHORIZATION

T. PASTOR, CESO IV

1Regional Director

Top Management

1

I I I I

.. ~

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Republic of the Philippines DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT

DILG Regional Office No. 5, Rizal St., Legazpi City http://regions.dilg.gov .ph

Name of Bureau/Servlce/ Divis ion:JJi.Mfil!

MASTER LIST OF RECORDS

DOCUMENT CODE DOCUMENT TITLE CUSTODIAN LOCATION FILING SYSTEM

FOLDER SCHEME Co ·' .. ~. \- :l.~-:;. ' "-l'.'t..~ - . ·., ~ ~. d 1 ·",:.:..,-

Document Control Request M. B Cabinet 1, QMS Reports YYYY By Date • Quality Procedure (QPJ . drawer2 (Latest on Quality Objective (QO) Top) • Master List of internal Documents • Master List of External Documents • Risk Register Objective • Risk Register Process • Checklist of Documentary Requirements L TIA Assessment Log Sheet

LTIA Forms 1-7

~:no;~"I'!TI~'i'::!~0'.'!''.'':rf~: ; ► .;e_: ;,,~:•i;;•4 J. , .. : /41;

*Process Quality Monitoring and Evaluation M. B Cabinet 1, By Date (QME) drawer 2 (Latest on • Customer Satisfaction System Top)

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RETENTION PERIOD

ACTIVE STORAGE TOTAL DISPOSAL

. 3 yrs 3 yrs 6yrs shredding/re

use

3 yrs 3 yrs 6 yrs shredding/re-use

Republic of the Philippines DEPARTMENT OF TilE INTERIOR AND LOCAL GOVERNMENT

DILG Regional Office No. 5, Rizal St, l.egaipl City reglonS.dilg.soy,ah

Name of Bureau/ Service/ Division: _LGMED

MASTER LIST OF INTERNAL DOCUMENTS

DOCUMENT CODE DOCUMENT TITLE 00 01

'111:UANCE OF CERTIFICATE OF SERVICES RENDERED FOR THE SANGGUNIAN MEMBERS ELIGIBILITY fCSC SM£ FORM 11

Regional Memorandum 218 Lupong Tagapamayapa Incentives Awards (L TIA) Indicative Jan. 6, 2018 Schedule

DILG R.O Form l LTIA 2018 Official Entry For Submission to Central Office 2017

QP·ROS-LGMED-03 L TIA Assessment Quality Procedure

QO·QP-ROS-LGMED-03 L TIA Assessment Quality Objecuve

QME-QP-ROS-LGMED-03 LTIA Assessment Quality Monitoring & Evaluation (QME)

FM-QP-ROS-LGMED-03·0 I L TIA Assessment Summary Logsheet (PSL)

FM·QP·ROS·LGMED-03-02 Checklist of Documentary Requirements

FM•QP-ROS-LGMED-03-03 Issuance ofCSC Customer Satisfaction Survey Form

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REVISION 02 03 04 OS

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Reoublic of the Philiooines DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMEN1

DILG Regional Office No. 5. Rizal St Legazoi Citv regionS.dilg.gov.ph

Name of Bureau/Service/Division: LGMED

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DILG Memo-Circular# 2008-102 -Reiterating and I 6/17/2008

supplementing DILG Memo Cir-2004-43 dated 14

April 2004 Relative to the Lupong Tagapamayapa Incentives Awards Guidelines

DILG Memo-Circular # 2016-58-Reiterating and I 7/29/2016 supplementing DILG Memo Cir-2008-102 dated 17

June 2008 Relative to the Lupong Tagapamayapa Incentives Awards Enhanced Criteria & Guidelines

,DILG Memorandum -2018 Lupong Tagapamayapa

Incentives Awards (L TIA) Indicative Calendar

IL TIA FORM 06-Summary of Cases

,LTIA Form 07 - Performance Highlights

LTIA Form 07-A - List of Cases L TIA

Form 07-8 - Lupong Tagapamayapa Profile

1/3/2018

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DOCUMENT CODE

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DOCUMENT TITLE REVISION/EDITION

L TIA Form 01 - Performance Evaluation Form L TIA Form OZ-Consolidated Performance Evaluation Form L TIA Form 03 (C/M)-Comparative Performance Evaluation Form L TIA Form 04 - Performance Validation Report Form LTIA Form 05 - Official Entry Form LTIA Form 05 A-Non-Submission of Official Entry

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DILG - REGION V (BICOL REGION)

CSS Summary Logsheet

Office: LOCAL GOVERNANCE MONITORING AND EVALUATION DIVISION (LGMED) Process/ Service: LTIAASSESSMENT

No,

Total

%

Date Survey Form Issued

Survey Mode (in person, electronic

Client Name Date CSS Form

Received

Unsatisfactory and Below

:2. 1

Satisfactory or Above Rating

:3, 4, S

Process Owner Division/Unit Cbtef

Supervising Admin. Officer-FAD QMS Secretariat Head

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r. ARNALDO E. ESCOBERtjR, CESO V ore Assistant Regional Director Rqlonal QaaUty Management

Representative Restonal Director

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Remarks, if any

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DILG - REGION V (BICOL REGION) CUSTOMER SATISFACTION SURVEY MATRIX

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Quality Objective: At least 80% average Satisfactory (3) and above ( 4, 5) rating from received Customer Satisfaction Survey Forms/Survey Tools

Schedule of submission: Every 5th working day of the ensuing month of the monitoring period

NAME OF PROCESS

OFFICE (Indicate the name of

the process as it appears in the

document quality procedures)

LGMED L TIA Assessment

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CUSTOMERS (Specify the customers of

the process, e.g. field offices,

LGUs/Officials/Employe es, and/or the general

public)

LGUs

FREQUENCY MODE OF SURVEY TOOL (the frequency

SURVEY (Indicate whether should be the

(specify css form or same with the

monitoring whether in specify the name

person, mail or of other survey period indicated

electronic) tool used) in your process quality objective

(QO) form)

Person CSS Form Quarterly

SAMPLE SIZE TARGET RESPONSIBLE

(Indicate the RESPONSE PERSON percentage from RATE (Indicate the name of

the total the personnel ( ensure that the responsible for

customers for results can the period to be reliably represent

monitoring the

given survey the "voice" of the customer satisfaction

objective and tool) customers) submittin11 reoortsl

100% 80% NEDITA B. BALUCIO

DILG - REGION V (BJCOL REGION)

L TIA Assessment r@•iiih4hiifui

FM-QP·ROS-Jgmed-25· •XX I R<'v. No. Efl. Date !'age

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LTIA CUSTOMER SATISFACTION SURVEY FORM

NAME (Optional): ______________ _ Date:. ______ _

Dear Client,

We at DILG Region V commit to provide the best service available and meet your expectations. In our effort to determine the effectiveness of our service and to help us improve on other elements, we will appreciate your assistance in accomplishment of the . herein survey. Please encircle the rating that reflects your impression or satisfaction level about our services.

Moreover, feel free to· include any additional comments you deem necessary or relevant to improving our services. Your response and time is greatly appreciated. Thank you!

Rating Scale 5 4 3 2 1

Description /Satisfaction Level Very High

High Moderate

Low Very Low

A. Parameter Client Satisfaction Remarks

1. Knowledge on Criteria/Indicators 5 4 3 2 1

2. Conduct of Assessment 5 4 3 2 1

3. Timeliness of Assessment 5 4 3 2 1

B. Overall Impression 5 4 3 2 1

C. Suggestion for Improvement

THIS DOCUMENT IS CONTROLU.m AND NOT TO BE !UH'IWDlJCED WITHOUT AUTHORIZATION

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Republic 9f t he Phllippines

DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT

DILG Regional Office No. 5, Rizal St., legazpi City regionS.dilg.gov.ph

Checklist of Documentary Requirements (Pursuant to DILG MC 2016--SB dated April 29, 2016

reltl!rating and suppleml!!nting DILG Memorandum Cir-c:1,1tar No. 2008-102, dated June 17, 2008 re-lati'lle to the Lu pong l agapamayapa lncentiv~ Awards Enhanced Criteria and Guide-lines-)

Date of LCEs Letter-Request Date Received Name of LCE Requesting LGU

~•· .• ,. "i :,, ,,, •. ,,-,',\_ DOC R~ 1. Form 1· Performance Evaluation Form ( R.O Use) 2. Form 2 - Consolidated Performance Evaluation Form (R.O Use) 3. Form 3 - Comparative Performance Evaluation Form (R.O Use) 4. Form 5- Offlcia I Entry Form

Offlcet .

1:,·,,-.,,;;,\,. ':• a. ~ EN:t'ARY REQt,IIREMENl'S'( ~ lilncla(OfflceL~ 1. Form 3 (P)/(C/M)·Comparative Performance Evaluation Form

2. Covered Page

3. Table of Contents

4. Executive Summary

5. Form 6 - Summary of Cases

6. Form 7-A- Performance Highlights:

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"'" :~;,JtA'f~fl(l~GW<l~,l!ATIONS "' R,f/\¥,, 1. Observance of Settlement Procedures & Settlement Deadlines:

► Attach 2 photos of the record book and sample entries

► Attach 4 photos with caption-on on-going settlement of dispute

2. Systematic Maintenance of Records: Attach 2 photos with caption:

► Record Books in reference to assessment

► Computerized Records of Cases

► Compilation of the Notices of Meetings, Minutes of Lupon Meetings with Attendance Sheets

► Compilation of Copies of Reports submitted to the Court and t o the DILG

► Filing Cabinet/s

3. Timely Submission of Reports to Concerned Agencies

► Attach transmittal letters of report submitted to the concerned agencies

4. Conduct of Monthly Meetings Exclusively on KP Matters: Attach the ff.

► Copy of notices of Meetings

► Minutes of Lupon Meetings

► 3 Phot os with caption of on-going meeting

~ CTIVENESS IN RING ~ OF 1.NTERPERSONAL ~ :;.. i~, {,ti'-~OBJE F TH , UNG4HG'PAM~GAY 1. Quantity of Settled Cases against filed:

► Attach Form 7-A - List of Cases

2. Quality of Settlement of Cases

3. At least 80% Compliance

► Attach 5 samples of proof of compliance "!;-C. '""7'"#',_N.:J;,~ : 111-CllfATIVllY AND ~EAALNESS OF THE LT tfi( ,,

1. Settlement Techniques

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► Attach 2 ohotos w ith caption of application of each settlement

2. Coordination with Concerned Agencies

► Attach 2 ohotos with caption, letters, emails, Visitor's Loabook as nroof

2. Sustained Info drive

► Attach 2 Photos with caption oft~ info drive used bv LT

3. KP Training

► Attach 2 ohotos with caotion of each tralnina conducted JV- MEA Oil FACIUTY FOIi ICP ACTMTlES

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1. Building Structure or space:

► Attach 3 ohotos w ith caotlon

' \/-FINANCIAL 011 NON-RNMCIAl SUl'l'OllT ~

1. P/C/M Government & NGAs

► Attach oroof of suooort, financial or non-financial

2. POs/NGOs

► Attach oroof of support, financial or non-financial

7-B - Lupong Tagapamayapa Profile . Remarks/Action to be Taken I ---- •,u~ ,

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