DEPARTMENT OF SOCIAL WELFARE AND DEVELOPMENT

SUPPLEMENTAL FEEDING PROGRAM

WEIGHT MONITORING FORM

Name of DCC
Name of DCW
Brgy./City or Municipal / Province

NUTRITIONAL STATUS
REMARKS
UPON ENTRY 1 MONTH AFTER 2 MONTHS AFTER
NAME OF CHILDREN SEX
DATE OF AGE (in HEIGHT (in WEIGHT (in *DEWORMING *VIT. A NUTRI- DATE OF AGE (in HEIGHT WEIGHT (in NUTRI- DATE OF AGE (in HEIGHT WEIGHT (in NUTRI-
WEIGHING mos.) cm) kilos) (1ST DOSE) SUPPLEMENTATION TIONAL WEIGHING mos.) (in cm) kilos) TIONAL WEIGHING mos.) (in cm) kilos) TIONAL
(1ST DOSE) STATUS STATUS STATUS

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This form shall be used every month by the DCW in recording weight and height of the child to determine the improvement in child's nutritional status
* DCW should indicate date or month & year when the child was dewormed & provided Vit. A
Nutritional Status:
SU - Severly Underweight PREPARED BY: ATTESTED BY:
UW - Underweight
N - Normal MICHELLE B. BETITO/DCW
OW - Overweght NAME/POSITION DATE NAME /POSITION DATE