Professional Documents
Culture Documents
Total No. of Female Learners With Consent
Total No. of Female Learners With Consent
School ID: _________ Name of School: ____________________ Address: ________________________________________________ Total No. of Sections/
Classrooms: ____
Total
Submitted by: Validated by: Noted by:
__________________________________ ____________ ___________________________________ _____________________________ ____________
Grade Level Chairman Date School Nurse Principal Date
ear:_________
. of Sections/
Reporting Form 2b-Grade Level
School Based Weekly IronFollc Acid (WIFA) Supplementation
Given WIFA Not given WIFA Total No. of WIFA is not give
Enrollment Supplements Supplements (based in codes)
Total No. of
Grade Sections/Classr
Level REMARKS
ooms Total No. of Total No. of Total No. of
Enrolled Female Female Learners Number % Number % 1 2 3
Learners Learners with consent
Total
Submitted by: Validated by: Noted by:
School ID: _________ Name of School: ____________________ Address: ________________________________________________ Total No. Schools: _____
Given WIFA Not given WIFA Total No. of WIFA is not give
Enrollment Supplements Supplements (based in codes)
Total
Submitted by: Validated by: Approved by:
Region: __________ Division: ____________ Date: __________ Total No. Of Districts: __________________________________
Given WIFA Not given WIFA Total No. of WIFA is not give
Enrollment Supplements Supplements (based in codes)
Name of Total No. of REMARKS
District Schools Total No. of Total No. of Total No. of
Enrolled Female Female Learners Number % Number % 1 2 3
Learners Learners with consent
Total
Submitted by: Validated by: Noted by:
Given WIFA Not given WIFA Total No. of WIFA is not give
Enrollment Supplements Supplements (based in codes)
Total
Submitted by: Checked by: Noted by:
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*Consent Given
Submitted by: Noted by: Codes for reasons why WIFA is not given
1. Not Dewormed
__________________________________ ____________ __________________________________ _____________ 2. On therapeutic treatment for anemia
Class Adviser Date Grade Level Chairman Date 3. with persistent mild reaction like gastric discomfort
astric discomfort