Académique Documents
Professionnel Documents
Culture Documents
Department of Education
Region ___
No.
Name
Sex
hs
Prepared by:
__________________________________
Feeding Focal Person
BMI
Date of
in
for 6
Weig Heig
Date of Birth
Weighing /
Years
y.o.
(MM/DD/YYY
Measuring
ht
ht
/
and
Y)
(MM/DD/YYYY
(Kg) (cm)
Mont
abov
)
Participa
Nutritio
tion in
nal
4Ps
Status
(NS)
(yes or
no)
Name of
Parents
Beneficiary of
SBFP in
Previous Years
(yes or no)
Note: This form shall be prepared by the school, to be compiled by the DO, and for final compilation by the RO, for submission to DepEd-HNC
SBFP Form 2
Department of Education
Region ___
Name of Schools
BEIS ID No.
School Address
Prepared by:
Name of District
Total
Supervisors/
Name of Barangay
Contact Number Beneficiari
School Principal
es
or OICs
Noted by:
Unit Chief
Note: This form shall be prepared by the DO, for final consolidation by the RO, for submission to DSWD-FO, copy furnished DepEd-HNC
SBFP Form 3
Department of Education
Region ___
Number of Undernourished
No. of
School Children by Grade
Severely
Level
Wasted
No. of
Wasted
Total
Beneficiar No. of 4 Ps
Beneficiaries
ies
No. of Pupils
who are
beneficiaries
in previous
years
Remarks
1. Kinder
2. Grade I
3. Grade II
4. Grade III
5. Grade IV
6. Grade V
7. Grade VI
Total
Prepared by:
______________________________________
SBFP DepEd Focal
Note: This form shall be prepared by the school, to be compiled by the DO, and for final compilation by the RO, for submission to DepEd-HNC
Note: This form shall be prepared by the school, to be compiled by the DO, and for final compilation by the RO, for submission to DepEd-HNC
SBFP Form 4
SCHOOL-BASED FEEDING PROGRAM
RECORD OF DAILY FEEDING
NAME OF PUPIL
4Ps
Beneficiary Beneficiary
(y or n)
of Previous
SBFP
(y or n)
School: _____________________________________
Grade: __________ Section _____________________
ACTUAL FEEDING
PRE FEEDING
Age
Birth
Date
Sex
Ht
Nutritional Status
Wt
Date
cm
kg
Taken
NS
Deworming
( ) or Date
(X) Taken 1
9 10 11 12 13 14 15 16 17 18 19 20
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
TOTAL:
Prepared by:
LEGEND
____________________________
Feeding Teacher / School Nurse
A. Nutritional Status
For 6-19 y.o
B. Deworming
D. Actual Feeding
SW - Severely wasted
SU - Severely underweight
( x ) - not dewormed
( ) - Present, served
W - Wasted
U - Underweight
( ) - dewormed
N - Normal
N - Normal
Ow - Overwieght
Ow - Overwieght
O - Obese
Page 7
Note: This form shall be prepared by the school to be consolidated using SBFP Form 5
Page 8
SBFP Form 4
SCHOOL-BASED FEEDING PROGRAM
School: _____________________________________
Grade: __________ Section _____________________
ACTUAL FEEDING
NAME OF PUPIL
21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
TOTAL:
D. Actual Feeding
( ) - Present, served
( A ) - Absent, not served
( ) - Present, served twice
page 2
SBFP Form 4
SCHOOL-BASED FEEDING PROGRAM
School: _____________________________________
Grade: __________ Section _____________________
ACTUAL FEEDING
NAME OF PUPIL
61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
TOTAL:
D. Actual Feeding
( ) - Present, served
( A ) - Absent, not served
( ) - Present, served twice
page 3
SBFP Form 4
SCHOOL-BASED FEEDING PROGRAM
School: _____________________________________
Grade: __________ Section _____________________
ACTUAL FEEDING
NAME OF PUPIL
101 102 ### 104 105 ### ### ### ### ### 111 112 113 114 115 116 117 118 119 120
POST FEEDING
Nutritional Status
Ht
Wt Date
cm
kg Taken NS
ATTENDANCE
Days
Present
Feeding
Days
Percentage
(A)
(B)
(A/B)*100
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
TOTAL:
AVERAGE:
D. Actual Feeding
( ) - Present, served
( A ) - Absent, not served
( ) - Present, served twice
page 4
page 4