Campaign Monitoring Checklist Form MCL
Name of Field Monitor Date of event
Position/Designation Organization
Name of Candidate/s (list name/names ) Elective office sought
Name of Party Type of Party: Political Party
Municipality/City/Province Party-List Org.
Type of Event: Location/venue of the event: Local
Miting de Avance Open space Constituency Regional
Door to door campaign Indoor stadium of the Party Provincial
National
Campaign sortie Plaza
Motorcade Gov’t/public building Duration of (ex. 1:00-2:00pm)
Forum/Seminar Hotel/restaurant event (start-
Other (pls. specify below) Covered court end time)
___________________ Other (pls. specify below) Was the COMELEC field
Yes
office notified of event? No
___________________ _______________________
Name & address of venue (ex. Rizal Plaza, Main Avenue, Metro City)
Name of event organizer
EVENT DETAILS, LOGISTICS AND AMENITIES
Was any technical equipment used during the event? (ex. Sound system, lights, etc.) Yes No
If YES, pls. describe:
Was there a stage or raised platform during the event? Yes No
If YES, pls. describe:
Was there electricity provided or used during the event? (ex. generator, venue-provided) Yes No
If YES, pls. specify source:
Were refreshments or food items distributed/served to the people who attended? Yes No
If YES, pls. specify & estimate number: (ex. 100 sandwiches, 100 soda cans, 100 water bottles)
Were there giveaways or items distributed freely? (ex. baseball caps, t-shirts, pens, fans) Yes No
If YES, pls. describe & estimate number: (ex. 100 shirts, 50 caps, etc.)
Were there tents, tables, and chairs rented/setup for the event? Yes No
If YES, pls. specify & estimate number: (ex. 3 20x20 tents, 20 tables,40 chairs)
Was any form of transportation provided to the persons who attended the event? Yes No
If YES, pls. describe & estimate number: (ex. 2 pickup trucks with red plate, rented coaster/bus/jeep, etc.)
Were there any event staff present during the event? Yes No
If YES, pls. specify & estimate number: (ex. 10 ushers/marshals, 20 bodyguards/security, 2 photographers, etc.)
Was there any form of entertainment provided during the event? Yes No
If YES, pls. describe: (ex. live performance by XYZ, fireworks display, etc.)
Was the event promoted or publicized in any way? (ex. streamers, radio ads, mobile ads, etc.) Yes No
If YES, pls. describe: (ex. 15-sec radio ad, ¼ page on local paper, mobile ad on L300 van, etc.)
DESCRIPTION OF THE EVENT (may be continued on the back page of checklist)
Campaign Monitoring Checklist Form MCL
DESCRIPTION OF THE EVENT (continued from the front page)
MONITOR’S UNDERTAKING
I, ______________________, of legal age, Filipino, with residence and postal
address at ________________________________________, do hereby certify under
oath that:
1. I personally accomplished the above Campaign Monitoring Checklist after
conducting an ocular inspection of the premises where the rally or meeting was held
at the date and time stated in the first page of this document.
2. I have read all the information contained therein and they are all true and
correct of my own personal knowledge.
3. The foregoing Campaign Monitoring Checklist was not amended nor in any
manner modified, and accordingly, the same may be relied upon should there be a
legal issue as to its veracity.
4. Should there be a complaint filed where the contents of the Monitoring
Checklist are in issue, I am willing to be a witness to identify and authenticate the
same.
IN WITNESS WHEREOF, I have set my hand to this Undertaking on
____________ 2016 at ________________.
__________________________________
Monitor’s signature over printed name
ACKNOWLEDGMENT
Subscribed and sworn to before me this ____ day of ______________, 2016, at
_____________________, affiant exhibiting to me his/her identification document
____________________ which contains his/her photography and signature, bearing number
_____________, issued by ___________________ on ___________________.
NOTARY PUBLIC/
OFFICER AUTHORIZED TO ADMINISTER OATH
Doc. No. :_____
Page No. :_____
Book No. :_____
Series of 2016.
