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Department of Education
Region XI
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__________________________________ _____________________________________
Feeding Focal Person School Principal / Officer-in-Charge
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 DSWD-FO, copy furnished DepEd-HNC
SBFP Form 2
Department of Education
Region XI
District Supervisor
Principal
Feeding Coordinator
1. Kinder 0
2. Grade I 0
3. Grade II 0
4. Grade III 0
5. Grade IV 0
6. Grade V 0
7. Grade VI 0
8. SPED 0
Total 0 0 0 0 0
______________________________________ _________________________________
School Based Feeding Coordinator School Principal
Note: This form shall be prepared by the school, to be compiled by the SDO, and for final compilation by the RO, for submission to DepEd BLSS-SHD
Remarks
0
SBFP Form 4
SCHOOL-BASED FEEDING PROGRAM
RECORD OF DAILY FEEDING
FOR THE MONTH OF ______________________ , SY 2018 - 2019
Region XI
Division Davao City School: _____________________________________
District ___________________________ School ID Number: ______________________
ACTUAL FEEDING
Beneficiary PRE FEEDING
4Ps
of Previous
NAME OF PUPIL Beneficiary
SBFP Nutritional Status Deworming
(y or n) Ht Wt Date Date
(y or n) Age Birth Date Sex (√ ) or
NS
cm kg Taken (X) Taken 1 2 3 4 5 6 7 8 9 10 11 12
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TOTAL:
Prepared by:
LEGEND
_________________________________ A. Nutritional Status
B. Deworming D. Actual Feeding
School Feeding Coordinator For 6-19 y.o For below 6 y.o
SW - Severely wasted SU - Severely underweight ( x ) - not dewormed ( √ ) - Present, served
W - Wasted U - Underweight ( √ ) - dewormed ( A ) - Absent, not served
N - Normal N - Normal (√√ ) - Present, served twice
Ow - Overwieght Ow - Overwieght
O - Obese
Note: This form shall be prepared by the school to be consolidated using SBFP Form 5
Page 6
___________
L FEEDING
13 14 15 16 17 18 19 20
tual Feeding
ed
erved
ed twice
Page 7
SBFP Form 4
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
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TOTAL:
D. A
( √ ) - Present,
( A ) - Absent, n
(√√ ) - Present,
page 2
53 54 55 56 57 58 59 60
D. Actual Feeding
( √ ) - Present, served
( A ) - Absent, not served
(√√ ) - Present, served twice
page 2
SBFP Form 4
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
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25
TOTAL:
D. Actual Feeding
( √ ) - Present, served
( A ) - Absent, not served
(√√ ) - Present, served twice
page 3
95 96 97 98 99 100
page 3
SBFP Form 4
D. Actual Feeding
( √ ) - Present, served
( A ) - Absent, not served
(√√ ) - Present, served twice
page 4
ATTENDANCE
Days Feeding
Percentage
Present Days
(A) (B) (A/B)*100
AVERAGE:
page 4
SBFP Form 5
SCHOOL-BASED FEEDING PROGRAM
SY 2018 - 2019
CONSOLIDATED NUTRITIONAL STATUS AND ATTENDANCE REPORT
Period Covered: JULY 2019 - SEPTEMBER 2019
Region: XI
Division: DEP- ED DAVAO CITY
District: DAVAO CENTRAL
School: WIRELESS ELEMENTARY SCHOOL
NUTRITIONAL STATUS
BEFORE (BASELINE) AFTER 40 DAYS
Total No. of No. of 4P's No. of Pupils
GRADE LEVEL
Beneficiaries Beneficiaries Dewormed
SW/SU % W/U % N % Ow % Ob % Total % SW/SU % W/U % N % Ow %
8 SPED 0 0 0 0 ### 0 ### 0 ### 0 ### 0 ### 0 ### 0 ### 0 ### 0 ### 0 ###
TOTAL 175 4 175 81 46% 94 54% 0 0% 0 0% 0 0% 175 100% 48 27% 88 50% 39 22% 0 0%
Legend:
For 6-19 y.o For below 6 y.o
SW - Severely Wasted SU - Severely Underweight
W - Wasted U - Underweight
N - Normal N - Normal
Ow - Overweight Ow - Overweight
O - Obese
0 0% 41 100% 96%
0 0% 13 100% 97%
0 0% 31 100% 98%
0 0% 18 100% 97%
0 0% 16 100% 98%
0 0% 36 100% 98%
0 0% 20 100% 98%
0 ### 0 ### 0%
0 0% 175 100% 97%