SBFP Form 2 (2021)

Department of Education
Region VII

SCHOOL-BASED FEEDING PROGRAM (SBFP) SUMMARY OF BENEFICIARIES & START OF FEEDING (SY 2021-2022)
Division/Province: SDO Masbate Province
City/ Municipality/Barangay : Mobo/ Guintorelan
Name of School / School District : Guintorelan Elementary School/ Mobo North
School ID Number: 113741
Date of Start of Feeding: __________________________
Last Mile School: __P_Y ___N
Nutritional Status at Start/End of Feeding No. of Secondary Targets No. of 4 No. of 4 Ps No. of Pupils Date Feeding
Learners Beneficiaries who are Started/Ended
SW W N OW+O SS S N T No. of Pupils- No. of No. of No. of Dewormed beneficiaries in
Number of Undernourished School at-risk-of- Stunted/ Indigent Indigenous previous years
Children by Grade Level dropping-out Severely Learners Peoples (IPs) (Repeaters)
(PARDOs) Stunted

1. Kinder 0 0 10 1 1 1 9 11 0

2. Grade I 0 0 15 2 0 3 14 17 17

3. Grade II 0 1 15 0 0 3 13 16 4

4. Grade III 0 0 11 0 0 2 9 11 6

5. Grade IV 0 1 9 0 0 2 8 10 4

6. Grade V 0 0 15 0 1 4 10 15 0

7. Grade VI 0 0 7 1 0 2 6 8 2

Total 0 2 82 4 2 17 69 88 33

Prepared by: Approved by:

SBFP DepEd Focal School Head

Note: This form shall be prepared by the school before the start of feeding and after feeding, to be compiled by the SDO, and for final compilation by the RO, for submission to DepEd BLSS-SHD
SBFP Form 1 (2021)
Department of Education
Region VII

Master List Beneficiaries for School-Based Feeding Program (SBFP) (SY 2021-2022)

Division/Province: ______________________________________ Name of Principal : __________________

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

Date of Weighing / Age in Weight Height

No. Name Sex Grade/ Section Date of Birth (MM/DD/YYYY) Measuring Years /
(MM/DD/YYYY) Months (Kg) (cm)

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(SY 2021-2022)

incipal : ____________________________________
eding Focal Person : _________________________

Nutritional Parent's
BMI for Beneficiary of
Dewormed? consent for Participation
6 y.o. Status (NS) milk? in 4Ps
SBFP in
and Previous Years
(yes or no) (yes or (yes or no)
above (yes or no)
no)
BMI-A HFA
 SBFP Form 3 (2021)
SCHOOL-BASED FEEDING PROGRAM
RECORD OF DAILY FEEDING

FOR THE MONTH OF ______________________ , SY 2021 -2022

Region
Division School: _____________________________________
District Grade: __________ Section _____________________
School ID Number: _________________________
NAME OF PUPIL ACTUAL FEEDING

1 2 3 4 5 6 7 8 9 10 11 12 13 14
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172
TOTAL:
Prepared by:

B. Deworming D. Actual Feeding

Feeding Teacher / School Nurse
( x ) - not dewormed (H ) - Present, served with Hot meals
Approved by: ( √ ) - dewormed (M ) - Present, served with Milk
(H/M ) - Present, served with Hot meals & Milk
( A ) - Absent, not served
School Head (H2/M2/(H/M2)) - Present, served twice

Note: This form shall be prepared by the school to be consolidated using the Revised OKD Form A.
15 16 17 18 19 20
 SBFP Form 3 (2021)

SCHOOL-BASED FEEDING PROGRAM

FOR THE MONTH OF ______________________ , SY 2021 - 2022

Region ___X_________________________
Division School: _____________________________________
District Grade: __________ Section _____________________
School ID Number: _________________________

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
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TOTAL:

D. Actual Feeding

(H ) - Present, served with Hot meals

(M ) - Present, served with Milk
(H/M ) - Present, served with Hot meals & Milk
( A ) - Absent, not served
(H2/M2/(H/M2)) - Present, served twice

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 SBFP Form 3 (2021)

SCHOOL-BASED FEEDING PROGRAM

FOR THE MONTH OF ______________________ , SY _2021 - 2022

Region
Division School: _____________________________________
District Grade: __________ Section _____________________
School ID Number: _________________________

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
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159
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TOTAL:

D. Actual Feeding

(H ) - Present, served with Hot meals

(M ) - Present, served with Milk
(H/M ) - Present, served with Hot meals & Milk
( A ) - Absent, not served
(H2/M2/(H/M2)) - Present, served twice

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91 92 93 94 95 96 97 98 99 100

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 SBFP Form 3 (2021)

SCHOOL-BASED FEEDING PROGRAM

FOR THE MONTH OF ______________________ , SY _2021 -2022_

Region
Division School: _____________________________________
District Grade: __________ Section _____________________
School ID Number: _________________________

ACTUAL FEEDING

NAME OF PUPIL

101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120
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TOTAL:

Prepared by; Approved by;

SBFP Focal Person School Head

D. Actual Feeding

page 4
 (H ) - Present, served with Hot meals
(M ) - Present, served with Milk
(H/M ) - Present, served with Hot meals & Milk
( A ) - Absent, not served
(H2/M2/(H/M2)) - Present, served twice

page 4
 ATTENDANCE
No. of No. of
Days Feeding Percentage
Present Days
(A) (B) (A/B)*100

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AVERAGE:

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SBFP Form 5 (2020)

DEPARTMENT OF EDUCATION
Region___X

REGI LANAO DEL NORTE / TUBOD WEST

NAME PIGCARANGAN INTEGRATED SCHOOL
SCHOO 501396

SCHOOL-BASED FEEDING PROGRAM - MILK COMPONENT

LIST OF AUTHORIZED CONSIGNEES (SY____2021-2022)

NAME & DESIGNATION TEL. NO. MOBILE NO. EMAIL ADD

1 (School Head)

2 (School Feeding Coordinator)

3 (School Property Custodian)

SCHOOL INSPECTION TEAM (SY 2021 -2022)

NAME & DESIGNATION TEL. NO. MOBILE NO. EMAIL ADD

3
SBFP Form 5 (2020)

Note: Only authorized consignees are allowed to receive the goods.

SBFP Form 5 (2020)

SPECIMEN
SIGNATURE

SPECIMEN
SIGNATURE

.
SBFP Form 5 (2021)

DEPARTMENT OF EDUCATION
Region X

REGION/DIVISION/DISTRICT: ______________________________________________________________________________
NAME OF SCHOOL: ______________________________________________________________________________
SCHOOL ID NO.: ______________________________________________________________________________

SCHOOL-BASED FEEDING PROGRAM - MILK COMPONENT

LIST OF BENEFICIARIES Classification

(SY________)of Students in terms of Milk Tolerance
(Please check one)
Without milk With milk Not allowed by
intolerance and will intolerance but parents to
Name Grade & Section participate in milk willing to participate in milk
feeding participate in milk feeding
feeding
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SBFP Form 5 (2021)

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SBFP Form 5 (2021)

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SBFP Form 5 (2021)

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SBFP Form 5 (2021)

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SBFP Form 5 (2021)

172

PREPARED BY; APPROVED BY:

SBFP FOCAL PERSON School Head

SBFP Form 6 (2021)

DEPARTMENT OF EDUCATION
Region ___X

REGION/DIVISION/DISTRICT: ______________________________________________________________________________
NAME OF SCHOOL: ______________________________________________________________________________
SCHOOL ID NO.: ______________________________________________________________________________

SCHOOL-BASED FEEDING PROGRAM

NFP DELIVERIES (SY 2021 -2022

Grade Level Number of Beneficiaries Date No. of Packs Received No. of Packs for
Delivered Replacement/
New Replacement Total (New + Rejected
Replacement)
Kinder
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
TOTAL:

MILK DELIVERIES (SY________)

Grade Level Number of Beneficiaries Date No. of Packs Received No. of Packs for
Delivered Replacement/
New Replacement Total (New + Rejected
Replacement)
Kinder
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
TOTAL:
SBFP Form 6 (2021)

Prepared by: APPROVED BY:

School Feeding Coordinator School Head

SBFP Form 6 (2021)

Remarks

Remarks