Republic of the Philippines
Department of Education
REGION XIII – CARAGA
SCHOOLS DIVISION OF AGUSAN DEL SUR
AGUSAN DEL SUR NATIONAL SCIENCE HIGH SCHOOL
BE FORM 1
BRIGADA ESKWELA
SY. 2021-2022
PHYSICAL FACILITIES AND MAINTENANCE NEEDS ASSESSMENT FORM
Instruction: Conduct an ocular inspection of the school physical listed below. Then provide the needed information to facilitate the improvement to be done on these
identified facilities. (If needed you may use separate forms for each classroom or school facility).
CONDITION
(Check One)
FACILITIES
Satisfactory
Unsatisfactory
Remarks
If
Unsatisfactory
, describe the
problem
Roofs/Gutters
Ceilings
Walls
Blackboards
Chairs/desks/tables
Water facilities/ Drainage
System
Signages
School garden
Lighting
Windows
School Code/BEIS No. 304704
Gov. D.O. Plaza Government Center, Prosperidad, 8500 Agusan del Sur
asnshs2002@gmail.com│304704@deped.gov.ph
242-2043│09283518405
Nature of
improvement
Needed
(e.g. Repair,
repainting,
replacement,
etc)
Material
Resources Needed
(Indicate kind and
quality)
Manpower Needed
(Indicate quantity and
nature of labor
services needed)
Republic of the Philippines
Department of Education
REGION XIII – CARAGA
SCHOOLS DIVISION OF AGUSAN DEL SUR
AGUSAN DEL SUR NATIONAL SCIENCE HIGH SCHOOL
Doors
Comfort Rooms
School Grounds
School Canteen/Clinic
School Fence/ wall
Electricity
Alternative gate
Reference Materials
Laboratory equipment
Prepared by:
Noted:
__ALGERD A. MOSCOSA___
School Physical Facilities Coordinator
_________________
Date of Inspection
School Code/BEIS No. 304704
Gov. D.O. Plaza Government Center, Prosperidad, 8500 Agusan del Sur
asnshs2002@gmail.com│304704@deped.gov.ph
242-2043│09283518405
______JINE L. HAVANA__
School Head