Annex A - Water Supply Projects-Final111518

Download as doc, pdf, or txt
Download as doc, pdf, or txt
You are on page 1of 2

ANNEX A

RAPID SUBPROJECT SUSTAINABILITY ASSESSMENT (RSSA)


FOR WATER SUPPLY SYSTEM
Date of Assessment
(mm/dd/yy):__________________________________________________________
(1)Program: SALINTUBIG BuB-PWS ADM-WS AM-WS
PAMANA-Water
Funding Year: ______________________________
Project ID: ______________________________

(2)Title of Project:
________________________________________________________________________
Project Location (Sitio/Purok, Brgy, Municipality,City, Province): -
_________________________
______________________________________________________________________________________
Mode of Implementation: By Contract By Administration
Level of Service: Level I Level II Level III Level II & III
Nature of Project: New Construction Upgrading Expansion
Rehabilitation

(3)Source of Funds:
National Subsidy PHP
LGU Counterpart PHP
Other Source of Fund (Please
PHP
Specify)_______________________
Total Project Cost PHP

(4)Date Project Completed (mm/dd/yy): _______________________________________________

(5)Is the Project booked-up as LGU asset? (Refer to LGU Accountant)


Yes (Attach proof of booking-JEV and attachment) No

(6)Is it still FUNCTIONAL? Yes No

(6.a) If YES:
System in place are in good working condition Suitable for
Drinking
(6.b.1) If NO, state the reasons:
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
(6.b.2) No. of Months NON-FUNCTIONAL: ________________

(7)CATEGORY OF NON-FUNCTIONALITY:
DISASTER SOURCE DESIGN CONSTRUCTION MAINTENANCE
INSTITUTIONAL

(8)Is it still OPERATIONAL? Yes No

(8.a) If YES:
System is being managed Sufficient Supply of Others (specify)
_______________________
Who manages the facility? __________
BWSA LGU Managed Water Districts Others (specify)
_________

Page 1 of 2
ANNEX A
If managed, does it have the following attributes? (Tick all items applicable)
List of Officers Registered by an accredited entity (DA, SEC...) By
Laws
Tariff Collection - How much? PHP ____________ per container or per week or per
month
Is the facility regularly maintained? Yes No
Is there water quality test conducted? Yes No
If yes, how frequent? every 3 mos every 6 mos once a year

How much is the annual maintenance budget? PHP______________________________________

(8.b.1) If NO, state the reasons:


_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
(8.b.2) No. of Months NON-OPERATIONAL: ________________

Is the community aware of the project facility? Yes No


Is the facility being used according to its intended purpose? Yes No
If No, why? ______________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________

(9)Needed interventions to make it functional/operational and its estimated cost.


(Prioritize the need according to urgency)
Needed Improvements Estimated Responsible
Estimated Cost
Interventions made (If any) Cost Office
(9.b)
(9.a) (9.c)
1.
2.
3.

Photos: (Please attach)

Prepared by: Verified by:

___________________________ _____________________________
LGU C/MLGOO

NOTED:

_____________________________
Cluster Head

Page 2 of 2

You might also like