BNS Form No.

4
Philippine Plan Action for Nutrition

MONTHLY ACCOMPLISHMENT REPORT

For the Month of __________, 20____

Province: BATANGAS Municipality: _____________ Barangay: ___________ Name of BNS: ____________________

Activity TARGET NO. REACH THIS MONTH LAST MONTH THIS

NUMBER (As Old cases New Cases TOTAL MONTHS
Stated in the (Cases reached (Cases reach TOTAL
BNS Action in the previous for the first (Write the
Plan) month again time) entry from 6 (Add column
this month) of last month’s 4 & 5)
report)

(1) (2) (3) (4) (5) (6)

A. WEIGHING ACTIVITIES

1. Full weighing
- All preschoolers (0-59 months)
2. Monthly Reweighing
- 0-23 months
- Severely Underweight Preschoolers
– Underweight Preschoolers
3. Quarterly Weighing
4. Household Survey

B. REFERRALS

1. To Feeding Center
- Underweight Preschoolers
– Severely Underweight Preschoolers
- Pregnant/Nursing Mothers
– Others (Specify)
___________________
___________________
2. To Health Center
- Underweight Preschoolers
- Severely Underweight Preschoolers
- Pregnant/Nursing Mothers
– Others (Specify)
___________________
___________________
3. To the Office of Municipal Agriculturist for
Distribution of seeds and seedlings
- Families with Sev and UW PS
– Others (Specify)
___________________
___________________
4. For Attendance to Mother Class

- Mother with Sev and UW PS

- Pregnant/Lactating Mother
- Others (Specify)
_________________
_________________
 Activity TARGET NO. REACH THIS MONTH LAST MONTH THIS
NUMBER (As Old cases New Cases TOTAL MONTHS
Stated in the (Cases reaches (Cases reach (Write the TOTAL
BNS Action in the previous for the first entry from 6
Plan) month again time) of last month’s (Add column
this month) report) 4 & 5)

(1) (2) (3) (4) (5) (6)

C. OTHER ACTIVITIES

1. Organization / Reactivation of BNC

2. Attendance to BNS Meetings

3. Income Generating Activities

4. Information Campaign

- Immunization

– Environmental Sanitation

– Selective Food Production

– Family Planning

5. Home Visits

6. Others (Specify)

D. RESULTS OF FOLLOW UP WEIGHING

PARTICULARS 0-23 MONTHS UW & SUW 24-59 MONTHS

NUMBER WEIGHED
- No. of Normal
- No. of Underweight
a) Underweight
b) Severely Underweight
c) Overweight
- No. of New Case(s)
NUMBER NOT WEIGHTED
- Overage
- Moved Out
- Dead

Prepared by: ___________________________ Noted: ______________________________

Barangay Nutrition Scholar Brgy. Capt. And Chairperson, BNC

Approved: _________________________________
City/Municipal Nutrition Action Officer