SBFP FORM 5 Annex 7

SCHOOL-BASED FEEDING PROGRAM (SBFP)

FY: _____________

PROGRAM TERMINAL REPORT (PTR)

Region/Division : _______________________________
District : _______________________________
School : _______________________________
School ID No. : ________________
School Enrolment: _____________

Prepared by:
_____________________________ _____________________________
School Feeding / SBFP Coordinator School BAC

Noted by:
_____________________________ _____________________________
School Head PTA Representative

A. PROGRAM ACCOMPLISHMENT
Status of Implementation:
Completed __________ *indicate total number of feeding days
Discontinued __________ *indicate total number of feeding days
For continuation __________ *indicate total number of feeding days
TOTAL: ________ DAYS

Number of No. of No. of Pupils

Beneficiaries No. of Beneficiaries who are
Beneficiaries who are also 4Ps Previous
Grade Level Beneficiaries Beneficiaries of
Dewormed
Target Actual SBFP
No. % No. % No. %
Kinder
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
TOTAL:

FINANCIAL STATUS

Amount Allocated Amount Received fr DO Amount Disbursed Amount Liquidated

SBFP FORM 5 Annex 7

B. NUTRITIONAL STATUS OF BENEFICIARIES

MID FEEDING (AFTER 60 DAYS) AFTER FEEDING (AFTER 120 DAYS)

BEFORE
Nutritional Status FEEDING SW/S
W/U N OW O SW/SU W/U N OW O
U
Severely Wasted /
Underweight (SW/SU)
Wasted / Underweight
(W/U)
Normal (N)
Overweight (OW)
Obese (O)

TOTAL:

C. PERCENTAGE ATTENDANCE

Month Month Month Month Month Month Month Month Average of

0 1 2 3 4 5 6 7 Months

% Attendance of
Beneficiaries

D. ISSUES ENCOUNTERED and ACTIONS TAKEN and MONITORING FINDING

ISSUES ENCOUNTERED / M&E FINDINGS ACTIONS TAKEN / RECOMMENDATIONS

SBFP FORM 5 Annex 7

E. PROCUREMENT PROCESS

PROCUREMENT PROCESS Presence / Use of Documents

SMALL VALUE PHILGEPS Abstract of PO or Official

BIDDING RFQ RER
PROCUREMENT Certificate Quotation Contract Receipt

Note: Use if done/present or if not done/absent

F. GOOD PRACTICES or LESSONS LEARNED

SBFP FORM 5 Annex 7

G. PERSONNEL INVOLVED

Names of Names of Names of Others or Names of NGOs,

School Personnel Parents Barangay Officials Civic Groups, etc
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H. PICTORIALS

Notes: Use separate pages (at least 3)

Limit pictures to significant and relevant activities
Add captions, venue, date and activity

INSTRUCTIONS:

a. Editing of the format and structure of this Form is not allowed.

b. The SBFP Program Terminal Report shall be submitted per school to the Division Office after
120 Feeding days (Dec. 13, 2019) for consolidation by the Division Nurse using SBFP Form 6.

c. The schools must retain a copy as “School File” and incorporated in the SBFP Documentary
Records filing boxes/data bank/soft copy.