Republic of the Philippines

Province of INSERT Tarlac

Municipality of BARANGAY Victoria
LOGO BARANGAY SAN GAVINO

BARANGAY ANTI-DRUG ABUSE COUNCIL

August 06, 2018

JUAN DELA CRUZ

Municipal LGOO
Municipality of Victoria
Province of Tarlac

Dear Mr. Dela Cruz:

Pursuant to DILG
-DDB Joint Memorandum Circular No.
-01, 2018
I am formally submitting to your
officethe documents needed for the 2017 BADAC Functionality Assessment and Audit, to wit:

(1) Accomplished BADAC

-Assessment
Self and Audit Form;
(2) Accomplished BADAC
ata Capture
D Forms 1 to 6; and
(3) Duly signed documents as MOVs.

I furthercertify under penalty of law, based on information and belief formed after
reasonable inquiry, the statements and information
contained in these
document
s are true,
accurate and comple
te.
Thank you and
I amlookingforward to receiving any comments that you may have in relation
to the above.

Sincerely,

______________________________
Signature over Printed Name of Punong Barangay

[ Insert contact information of the barangay ]

 Republic of the Philippines
DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT
DILG-NAPOLCOM Center, EDSA cor. Quezon Ave., Quezon City
Telephone Number (02) 925-1137

BADAC FUNCTIONALITY SELF-ASSESSMENT AND AUDIT FORM

for the Year __________

Region: City/Municipality:

Province: Barangay: Contact #

FOR C/MLGOO / CD USE ONLY
Instruction: Put a check ✓ on the box that corresponds to the given questions.
INDICATORS BADAC Organizational Structure POINTS REMARKS
Copies of IDs issued to BADAC members
1. Is BADAC composed of at least seven (7) members?
Appointment papers
Others, please specify: ______________________

Executive Order (Required)

BADAC Organizational Structure
2. Did the BADAC organize a Committee on Operations? Copies of IDs issued to BADAC members
Appointment papers
Others, please specify:
______________________

Executive Order (Required)

3. Did the BADAC organize a Committee on Advocacy? BADAC Organizational Structure
Copies of IDs issued to BADAC members
Appointment papers
Others, please specify:
______________________

4. Did the BADAC organize a BADAC Auxiliary Team?

Executive Order w/ attached list of
YES NO MEANS OF VERIFICATION
updated
Executive Order (Required)
BAT members (Required)

IN COMPLIANCE WITH DILG-DDB JOINT MEMORANDUM CIRCULAR NO. 2018-01 BADAC FUNCTIONALITY SELF-ASSESSMENT AND AUDIT FORM
 FOR C/MLGOO / CD USE ONLY

INDICATORS YES NO MEANS OF VERIFICATION

BADAC Organizational Structure In case the CADAC/MADACs were not able to organize any consultation or POINTS REMARKS
Copies of IDs issued to BAT members planning workshop on reintegration program, the BADACs should
Appointment papers check the corresponding box for “N/A” in page 2, item number nine
Others, please specify: (9) of BADAC Self-Assessment and Audit Form. With respect to this, the C/M
______________________ LGOO or CD shall allocate the corresponding one (1) point
5. Did the BADAC organize House Clusters? Executive Order (Required)
BADAC Organizational Structure
Copies of IDs issued to House Cluster Leaders
Appointment papers
Others, please specify: ______________________

6. Did the BADAC designate Barangay Duty Officers Executive Order (Required)
(BDO)? BADAC Organizational Structure
Copies of IDs issued to Barangay Duty Officers
Appointment papers
Others, please specify: ______________________

Actual photo of the desk (Required)

7. Is there a desk or space in the barangay designatedas Others, please specify: ______________________
Referral/BADAC Desk?
Copy of Certificate of Participation (Required) Copy of
8. Did the Punong Barangay attend training on attendance sheet w/ the title of the activity, date/time, and
Strengthening BADACs, or other relevant trainings? venue Attestation from the lead organizer
YES NO N/A Others, please specify: ______________________

MEANS OF VERIFICATION

INDICATORS Copy of Cert. of Participation (Required) Copy of

attendance sheet w/ the title of the activity, date/time,
9. Did the Punong Barangay attend any training or and venue Attestation from the lead organizer
planning session on Community Support, Aftercare, and Others, please specify: _______________
Reintegration Program (CSAR)?
10. Did the BADAC conduct at least one (1) training for theBADAC Activity Report with attendance sheets (Required)
BADAC House Cluster Leaders?Photo/video documentation

IN COMPLIANCE WITH DILG-DDB JOINT MEMORANDUM CIRCULAR NO. 2018-01 BADAC FUNCTIONALITY SELF-ASSESSMENT AND AUDIT FORM
 FOR C/MLGOO / CD USE ONLY

INDICATORS YES NO MEANS OF VERIFICATION

Copies of evaluation or feedback forms POINTS REMARKS
Copy of signed liquidation report
Copy of Certificate of Participation awarded to cluster leaders

Others, please specify: ______________________

11. Did the BADAC conduct at least one (1) training for theBADAC Activity Report with attendance sheets (Required)
BADAC Auxiliary Team (BAT)? Photo/video documentation

Copies of evaluation or feedback forms

Copy of signed liquidation report
Copy of Certificate of Participation awarded to BAT members

Others, please specify: ______________________

12. Did the Barangay Duty Officers attend at least one (1)Copies of Certificate of Participation (Required)
training on Community-Based Rehabilitation Program orCopy of attendance sheet with title of the activity,
other relevant trainings?date/time, and venue
Photo documentation
Attestation from lead organizer

Others, please specify: ______________________

13. Did the BADAC conduct at least one (1) consultative BADAC Activity Report with attendance sheets

(Required)

IN COMPLIANCE WITH DILG-DDB JOINT MEMORANDUM CIRCULAR NO. 2018-01 BADAC FUNCTIONALITY SELF-ASSESSMENT AND AUDIT FORM
 FOR C/MLGOO / CD USE ONLY

INDICATORS YES NO MEANS OF VERIFICATION

meeting with stakeholders?Photo/video documentation POINTS REMARKS
Minutes of the meeting/proceedings
Others, please specify: ______________________
14. Did the BADAC conduct regular monthly meetings? Copies of BADAC monthly meeting minutes
Number of months in which meetings were conducted with attendance sheets (Required)
10-12 monthsPhoto/video documentation
8-9Minutes of the meeting/proceedings
6-7Others, please specify: ______________________
4-5
1-3
0
15. Did the BADAC organize / co-organize at least two (2) BADAC Activity Report (Required)
community-based IEC campaign activities?Attendance sheets

Photo/video documentation
Copies of evaluation or feedback forms
Copy of signed liquidation report
Copy of IEC materials used
Others, please specify: _______________________

16. Did the BADAC organize / co-organize at least one (1) BADAC Activity Report (Required)

school-based IEC campaign activity?Attendance sheets

IN COMPLIANCE WITH DILG-DDB JOINT MEMORANDUM CIRCULAR NO. 2018-01 BADAC FUNCTIONALITY SELF-ASSESSMENT AND AUDIT FORM
 FOR C/MLGOO / CD USE ONLY

INDICATORS YES NO MEANS OF VERIFICATION

Photo/video documentation POINTS REMARKS
Copies of evaluation or feedback forms
Copy of signed liquidation report
Copy of IEC materials used
Others, please specify: _______________________

17. Did the SK or any youth organizations in the barangay Activity report by the youth organization (Required)

conduct at least one (1) drug awarenessAttendance sheets

campaign activity?Photo/video documentation

Copies of evaluation or feedback forms

Copy of signed liquidation report
Copy of IEC materials used
Others, please specify: _______________________

18. Did any Civil Society Organizations (CSOs) conduct Activity report by the CSO (Required)

at least one (1) drug awareness campaign activity inAttendance sheets

the barangay?Photo/video documentation

Copies of evaluation or feedback forms

Copy of signed liquidation report
Copy of IEC materials used
Others, please specify: ______________________

IN COMPLIANCE WITH DILG-DDB JOINT MEMORANDUM CIRCULAR NO. 2018-01 BADAC FUNCTIONALITY SELF-ASSESSMENT AND AUDIT FORM
 FOR C/MLGOO / CD USE ONLY

INDICATORS YES NO MEANS OF VERIFICATION

POINTS REMARKS
19. Did the BADAC organize / co-organize any activities BADAC Activity Report (Required) in
observance of the International Day Against Drug Attendance sheets
Abuse and Illicit Trafficking (IDADAIT)?Photo/video documentation

Copies of evaluation or feedback forms

Copy of signed liquidation report
Copy of IEC materials used
Others, please specify: ______________________
20. Did the BADAC organize / co-organize any activities in BADAC Activity Report (Required) observance of the Drug Abuse Prevention and Control
Attendance sheets
Week (DAPC)? Photo/video documentation

Copies of evaluation or feedback forms

Copy of signed liquidation report
Copy of IEC materials used
Others, please specify: ______________________

21. Did the BADAC submit an updated number of residentsCopy of the Barangay Duty Officer's logbook, or who surrendered
through the Barangay Duty Officers andcopy of the logbook/reports from mandated agencies
other mandated agencies?where the resident surrendered (Required)

IN COMPLIANCE WITH DILG-DDB JOINT MEMORANDUM CIRCULAR NO. 2018-01 BADAC FUNCTIONALITY SELF-ASSESSMENT AND AUDIT FORM
 FOR C/MLGOO / CD USE ONLY

INDICATORS YES NO MEANS OF VERIFICATION

Others, please specify: ______________________ POINTS REMARKS

22. Did the BADAC submit an updated number of residentsCopy of referral letter from the barangay, received by
who were referred to higher ADACs and other lawCADAC/MADAC, or other law enforcement enforcement agencies for assessment?agencies
(Required)
BDO's logbook showing the referral date
Others, please specify: _______________________

23. Did the BADAC submit an updated number and status ofList of updated number and status of residents residents who were assessed and enrolled in
anyenrolled in Wellness and Recovery Interventions Wellness and Recovery Interventions?issued by CADAC/MADAC (Required)
Copies of Individual Treatment Card/Book
Others, please specify: _______________________

24. Did the BADAC submit an updated number of residentsList of updated number of residents who completed
who have completed prescribed Wellness and Recoverytheir prescribed Wellness and Recovery Interventions
Inteventions?issued by CADAC/MADAC (Required)
Copies of Certificate of Completion
Copies of clearance certificate issued by authorized service provider
Others, please specify: _______________________

25. Did the BADAC submit an updated number of residentsList of updated number of residents enrolled in CSAR
enrolled in CSAR or any equivalent reintegration program?program, or its equivalent, issued by
CADAC/MADAC (Required)
Copies of Individual Treatment Card/Book
Others, please specify: _______________________

IN COMPLIANCE WITH DILG-DDB JOINT MEMORANDUM CIRCULAR NO. 2018-01 BADAC FUNCTIONALITY SELF-ASSESSMENT AND AUDIT FORM
 INDICATORS Copies of Certificate of Completion, or copy of Clearance Certificate issued by authorized service
provider
26. Did the BADAC submit an updated number of residentswho
Others, please specify: _______________________
completed the CSAR or any equivalent reintegration program?
Certificate of submission from CADAC/MADAC and
local PNP unit (Required) Copy of received transmittal form
Others, please specify: _______________________
27. Did the BADAC submit the Summary of ConsolidatedInformation Certificate of submission from CADAC/MADAC and
Report (CIR)? local PNP unit (Required) Copy of received transmittal form
Others, please specify: _______________________

Copy of approved Barangay CSAR Plan, or equivalent, received by CADAC/MADAC (Required)

28. Did the BADAC submit an updated CIR to CADAC/MADACand
Others, please specify: _______________________
local PNP unit?
Copy of approved BADPA or copy of approved
BPOPS Plan with BADPA (Required)
Others, please specify: _______________________
29. Did the BADAC submit its Barangay CSAR or anyequivalent
reintegration plan as incorporated in their BADPA?
Copy of approved Barangay Annual Budget w/ budget allocation for BADAC (Required) Others,
please specify: _______________________
30. Did the BADAC prepare its own BADAC Plan of Action (BADPA) Total annual budget: _______________________
for FY 2017? Allocation for BADAC: _______________________

Copy of Annual BADAC Accomplishment and Fund

31. Did the BADAC appropriate a substantial budget for its anti-illegal Utilization Report (Required)
drug activities for FY 2017? Others, please specify: _______________________
_________________________________________________________ TOTAL POINTS
Signature over Printed Name of City/Municipal LGOO or City Director
Date signed: ________________ LEVEL OF FUNCTIONALITY
32. Did the BADAC submit its Annual BADAC Accomplishmentand
Fund Utilization Report to CADAC/MADAC and other agencies?

Audited by: FOR C/MLGOO / CD USE ONLY

YES NO MEANS OF VERIFICATION POINTS REMARKS
List of updated number of residents who completed Republic of the Philippines
the CSAR Program issued by CADAC/MADAC DEPARTMENT OF THE INTERIOR AND LOCAL
(Required)

IN COMPLIANCE WITH DILG-DDB JOINT MEMORANDUM CIRCULAR NO. 2018-01 BADAC FUNCTIONALITY SELF-ASSESSMENT AND AUDIT FORM
 Chairperson
DILG-NAPOLCOM Center, EDSA cor. Quezon /
Ave., Quezon City
Punong Barangay
Vice-Chairperson /
BADAC FUNCTIONALITY SELF-ASSESSMENT Peace & Order
AND AUDIT FORM
Committee Chair
for the Year __________
Members:

BADAC is Chair of Women &

composed of Family Committee
CERTIFICATION OF TRUTH, ACCURACY, AND COMPLETENESS seven (7) SK Chairperson
members
The undersigned certify under penalty of law, based on information andSchool
belief Principal /
formed after reasonable inquiry, the statements
Representative
and information contained in this document are true, accurate, and complete.
Brgy Chief Tanod
NGO / CSO
Representative
Faith-based Org
Signature over Printed Name of Chair of Committee on Advocacy Representative
Date signed: _________________ Adviser:

Local PNP Chief /

Representative
Chairperson /
Peace & Order
Signature over Printed Name of Punong Barangay / BADAC Chairperson
BADAC Committee Chair
Date signed: _________________
Committee on Members:

Operations is
Brgy Chief Tanod
Noted by: organized
BADAC Auxiliary
Refer to BADAC A
Team
Chairperson /
Women & Family
Signature over Printed Name of City/Municipal LGOO or City Director Committee Chair
Date signed: ________________ Members:

BADAC SK Chairperson
Committee on
Page 1 BADAC DATA CAPTURE FORM 1 Advocacy is School Principal /
INDICATOR POSITION FIRST NAME LAST NAME organized Representative
NGO / CSO
Representative
 Faith-based Org
Representative

P
age 2 BADAC DATA CAPTURE FORM 1
INDICATOR POSITION FIRST NAME LAST NAMENote: Use additional page if necessary. BAT shall be composed of one member per 80
BADAC residents; 25 members per 2,000 residents.
Auxiliary Team INDICATOR UNIT OF CLUSTER FIRST NAME LAST NAME SEX BIRTH DA
(BAT) is
organized
BADAC House
Clusters are
organized

Note: Use additional page if necessary. Examples of Unit of Cluster are by purok, by sitio, by
block, by zone, by street, etc.
CONCURRENT
INDICATOR DESIGNATION FIRST NAME LAST NAME SEX BIRTH DA
(if applicable)
Barangay Duty
Officers are
designated

Note: Use additional page if necessary. Concurrent Designation refers to the primary
appointment / item of the designated Brgy Duty Officer in the barangay, e.g. Barangay Health
Worker, VAWC Desk Officer, etc.
Page 3
BADAC DATA CAPTURE FORM 2
DURATION
INDICATOR ACTIVITY TITLE
DATE (MM/DD/YYYY) TIME
Trainings Attended
by Punong
Barangay on
Strengthening
 BADACs

Note: Use additional page if necessary.

DURATION
Note: Use additional page if necessary. INDICATOR ACTIVITY TITLE
DATE (MM/DD/YYYY) TIME
INDICATOR ACTIVITY TITLE
DATE (MM/DD/YYYY)
Trainings Attended
Trainings /
by Barangay Duty
Planning Session
Officers
Attended by
Punong Barangay
on CSAR Note: Use additional page if necessary.
Page 4
BADAC DATA CAPTURE FORM 3
DURATION
INDICATOR ACTIVITY TITLE
DATE (MM/DD/YYYY) TIME
Note: Use additional page if necessary.

INDICATOR ACTIVITY TITLE

Conduct of
DATE (MM/DD/YYYY)
BADAC
Consultative
Meetings
Trainings
Conducted by
BADAC for House
Cluster Leaders Note: Use additional page if necessary.
DURATION
INDICATOR ACTIVITY TITLE
DATE (MM/DD/YYYY) TIME
Note: Use additional page if necessary. Conduct of
BADAC Monthly
INDICATOR ACTIVITY TITLE Meetings
DATE (MM/DD/YYYY)
Trainings
Conducted by
BADAC for BADAC
Auxiliary Team
 DURATION
INDICATOR ACTIVITY TITLE
DATE (MM/DD/YYYY) TIME

Conduct of
Youthled IEC
Campaign
Activities

Note: Use additional page if necessary.

Note: Use additional page if necessary.
INDICATOR ACTIVITY TITLE DURATION
DATE (MM/DD/YYYY)
INDICATOR ACTIVITY TITLE
Organization/Coorganizatio DATE (MM/DD/YYYY) TIME
n of
Community-based
IEC Campaign Activities
Conduct of CSOled
IEC Campaign
Activities

Note: Use additional page if necessary.

Note: Use additional page if necessary.
DURATION
INDICATOR ACTIVITY TITLE
INDICATOR ACTIVITY TITLE DATE (MM/DD/YYYY) TIME
DATE (MM/DD/YYYY)
Organization/Coorganizatio
Organization/Coorganizatio n of
n of Activities in
School-based IEC Observance of the IDADAIT
Campaign
Activities

Note: Use additional page if necessary.

Note: Use additional page if necessary.
DURATION
Page 5 INDICATOR ACTIVITY TITLE
BADAC DATA CAPTURE FORM 3 DATE (MM/DD/YYYY) TIME
 Organization/Coorganizatio Tr
n of
Activities in He
Observance of the DAPC Faci
Week Moderate Outp
Tr

Severe Tr

NO. OF SURRENDERERS WHO COMPLETED WELLNESS

Note: Use additional page if necessary. &
INDICATOR RECOVERY INTERVENTIONS
MALE FEMALE TOTAL
BELOW 18 ABOVE 18 BELOW 18 ABOVE 18
P
age 6 BADAC DATA CAPTURE FORM 4 UNIFIED BARANGAY Submission of Updated
REPORT ON REFERRAL ACTION (UBRRA) Number of Surrenderers Who
Completed Wellness &
Recovery Interventions
The purpose of this form is to determine the number of surrenderers per semester (JanuaryJune,
Data provided herein are those recorded within the months of: January July-December), and monitor the number of who, among those surrenderers, have been
to June ( ) July to December ( ) referred, assessed, and who have completed any Wellness and Recovery Program interventions
__________________________ within the 6-month time frame. Counting shall restart at the onset of the new semester; meaning,
the data on those who surrendered in the previous semester shall no longer be accounted in the
NO. OF SURRENDERERS next, regardless of whether they have been referred or assessed in the following semester.
INDICATOR
MALE FEMALE
BELOW 18 ABOVE 18 BELOW 18 ABOVE 18

Submission of Updated P
Number of Residents who age 7 BADAC DATA CAPTURE FORM 5 COMMUNITY SUPPORT, AFTERCARE AND
Surrenderred REINTEGRATION (CSAR)

Data provided herein are those recorded within the months of: January to June ( ) July to
December ( )
STATUS / STATUS AND NO. OF ASSESSED SURRENDERERS
INDICATOR LEVEL OF NO. OF CSAR ENROLLEES
RISK MALE FEMALE INDICATOR INDICATOR
BELOW 18 ABOVE 18 BELOW 18 ABOVE 18 MALE FEMALE
TOTAL
BELOW 18 ABOVE 18 BELOW 18 ABOVE 18
Submission of
Updated Number Submission of Updated Submission of
Low Number of Residents
of Assessed Updated Numbe
Surrenderers Enrolled in CSAR Program,
Mild or its of
equivalent Residents Who
The purpose of this form is to determine the number of residents
enrolled in CSAR Program, or its equivalent, per semester (January-
June, July-December), and monitor the number of who, among
those enrolled, have completed the CSAR program within the 6-
month time frame. Counting shall restart at the onset of the new
semester; meaning, the data on those enrolled in the previous
semester shall no longer be accounted in the next, regardless of
whether they have been referred or assessed in the following
semester.
 P
age 8 BADAC DATA CAPTURE FORM 6 SUMMARY OF
CONSOLIDATED INFORMATION REPORT
as per Section 8 of DDB Board Regulation No. 3, s. 2017
Year (YYYY): _________

Data provided herein are those recorded within the months of: January
to March ( ) April to June ( ) July to September ( ) October to
December ( )

DRUG PUSHER DRUG USER / DEPENDENT

INDICATOR

PRESENT / ABSENT TOTAL PRESENT / ABSENT

Submission of
Updated Summary of
Consodated
CLANDESTINE CHEMICAL
Information Report CLANDESTINE DRUG WAREHOUSE
WAREHOUSE
(CIR)

PRESENT/ABSENT PRESENT/ABSENT