SBFP Form 1

Department of Education
Region V

Master List Beneficiaries for School-Based Feeding Program (SBFP)

Division/Province: SORSOGON/ SORSOGON Name of Principal : ____________________________________

City/ Municipality/Barangay : ____________________________ Name of Feeding Focal Person : _________________________
Name of School / School District : _________________________

BMI Participation
Date of Weighing / Age in Weight Height for 6 Nutritional Beneficiary of SBFP
No. LRN Name Sex Date of Birth
GRADE/Section Measuring Years / y.o. 4P'S ID No. in 4Ps Name of Parents in Previous Years
(MM/DD/YYYY) Months (Kg) (cm)
and Status (NS) (yes or
(MM/DD/YYYY)
no) (yes or no)
above

Prepared by:

__________________________________
Feeding Focal Person
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 V

SCHOOL-BASED FEEDING PROGRAM (SBFP) LIST OF SCHOOLS

Division/Province: SORSOGON/ SORSOGON

School District/City/ Municipality : ____________________________

Name of District
Total
Name of Schools BEIS ID No. School Address Name of Barangay Supervisors/ Contact Number
Beneficiaries
School Principal or OICs

Prepared by: Noted by:

SBFP DepED Focal Unit Chief

Note: This form shall be prepared by the DO, for final consolidation by the RO, for submission to DepEd-HNC
SBFP Form 3
Department of Education
Region V

SCHOOL-BASED FEEDING PROGRAM (SBFP) SUMMARY OF BENEFICIARIES & START OF FEEDING

Division/Province: SORSOGON/ SORSOGON

City/ Municipality/Barangay : ______________________________
Name of School / School District : _________________________
School ID Number: ________________________________________
Date of Start of Feeding: _________________________________

Nutritional Status at Start of Feeding

Number of Undernourished School
Children by Grade Level No. of No. of Pupils who
Severely No. of Total No. of 4 Ps are beneficiaries in
Wasted Wasted Beneficiaries Beneficiaries 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/ Teacher In- Charge of Feeding

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 4.1
SCHOOL-BASED FEEDING PROGRAM
RECORD OF DAILY FEEDING

FOR THE MONTH OF ________________, SY: ______________

Region : V
Division SORSOGON PROVINCE School: _ CABIGUAN ELEMENTARY SCHOOL
District: PILAR II Grade: KINDER Section: a.m. and p.m.

PRE FEEDING ACTUAL FEEDING POST FEEDING

ATTENDANCE
4Ps
NAME OF PUPIL Beneficiary Beneficiary Nutritional Status Deworming Nutritional Status Days Feeding
(y or n) of Previous Percentage
Ht Wt Date Present Days
SBFP
Age Birth Sex (√ ) or Date Ht Wt Date
NS
(y or n) Date cm kg Taken (X) Taken 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 cm kg Taken NS (A) (B) (A/B)*100

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25
TOTAL: AVERAGE:
Prepared by:
LEGEND
VILMA LOFAMIA - MANJARES A. Nutritional Status
B. Deworming D. Actual Feeding
Feeding Teacher / School Nurse 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
SONIA M. ANDES N - Normal N - Normal (√√ ) - Present, served twice
Elementary School Principal Ow - Overwieght Ow - Overwieght
O - Obese

Note: This form shall be prepared by the school to be consolidated using SBFP Form 5

Page 7
 SBFP Form 4.2
SCHOOL-BASED FEEDING PROGRAM
RECORD OF DAILY FEEDING
FOR THE MONTH OF ______________________ , SY _____________
Region : V
Division SORSOGON PROVINCE School: _____________________________________
District ___________________________ Grade: __________ Section _____________________

PRE FEEDING ACTUAL FEEDING POST FEEDING ATTENDANCE

4Ps Beneficiary Nutritional Status Deworming Nutritional Status Days Feeding
NAME OF PUPIL Beneficiary of Previous Percentage
Age Sex Ht Wt Date (√ ) or Date Ht Wt Date Present Days
(y or n) SBFP Birth NS
(y or n) Date cm kg Taken (X) Taken 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 cm kg Taken NS (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:
Prepared by:
LEGEND
____________________________ A. Nutritional Status
B. Deworming D. Actual Feeding
Feeding Teacher / School Nurse 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 8
 SBFP Form 4.3
SCHOOL-BASED FEEDING PROGRAM
RECORD OF DAILY FEEDING
FOR THE MONTH OF ______________________ , SY _____________
Region : V
Division SORSOGON PROVINCE School: _____________________________________
District ___________________________ Grade: __________ Section _____________________

PRE FEEDING ACTUAL FEEDING POST FEEDING ATTENDANCE

4Ps Beneficiary Nutritional Status Deworming Nutritional Status Days Feeding
NAME OF PUPIL Beneficiary of Previous Percentage
Age Sex Ht Wt Date (√ ) or Date Ht Wt Date Present Days
(y or n) SBFP Birth NS
(y or n) Date cm kg Taken (X) Taken 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 cm kg Taken NS (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:
Prepared by:
LEGEND
____________________________ A. Nutritional Status
B. Deworming D. Actual Feeding
Feeding Teacher / School Nurse 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 9
 SBFP Form 4.4
SCHOOL-BASED FEEDING PROGRAM
RECORD OF DAILY FEEDING
FOR THE MONTH OF ______________________ , SY _____________
Region : V
Division SORSOGON PROVINCE School: _____________________________________
District ___________________________ Grade: __________ Section _____________________

PRE FEEDING ACTUAL FEEDING POST FEEDING ATTENDANCE

4Ps Beneficiary Nutritional Status Deworming Nutritional Status Days Feeding
NAME OF PUPIL Beneficiary of Previous Percentage
Age Sex Ht Wt Date (√ ) or Date Ht Wt Date Present Days
(y or n) SBFP Birth NS
(y or n) Date cm kg Taken (X) Taken 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 cm kg Taken NS (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:
Prepared by:
LEGEND
____________________________ A. Nutritional Status
B. Deworming D. Actual Feeding
Feeding Teacher / School Nurse 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 10
 SBFP Form 4.5
SCHOOL-BASED FEEDING PROGRAM
RECORD OF DAILY FEEDING
FOR THE MONTH OF ______________________ , SY _____________
Region : V
Division SORSOGON PROVINCE School: _____________________________________
District ___________________________ Grade: __________ Section _____________________

PRE FEEDING ACTUAL FEEDING POST FEEDING ATTENDANCE

4Ps Beneficiary Nutritional Status Deworming Nutritional Status Days Feeding
NAME OF PUPIL Beneficiary of Previous Percentage
Age Sex Ht Wt Date (√ ) or Date Ht Wt Date Present Days
(y or n) SBFP Birth NS
(y or n) Date cm kg Taken (X) Taken 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 cm kg Taken NS (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:
Prepared by:
LEGEND
____________________________ A. Nutritional Status
B. Deworming D. Actual Feeding
Feeding Teacher / School Nurse 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 11
 SBFP Form 4.6
SCHOOL-BASED FEEDING PROGRAM
RECORD OF DAILY FEEDING
FOR THE MONTH OF ______________________ , SY _____________
Region : V
Division SORSOGON PROVINCE School: _____________________________________
District ___________________________ Grade: __________ Section _____________________

PRE FEEDING ACTUAL FEEDING POST FEEDING ATTENDANCE

4Ps Beneficiary Nutritional Status Deworming Nutritional Status Days Feeding
NAME OF PUPIL Beneficiary of Previous Percentage
Age Sex Ht Wt Date (√ ) or Date Ht Wt Date Present Days
(y or n) SBFP Birth NS
(y or n) Date cm kg Taken (X) Taken 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 cm kg Taken NS (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:
Prepared by:
LEGEND
____________________________ A. Nutritional Status
B. Deworming D. Actual Feeding
Feeding Teacher / School Nurse 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 12