BNS Form No.

1A
Philippines Plan of Action for Nutrition
FAMILY PROFILE
Purok / Sitio: _______________ Municipality: BAMBANG
Barangay : CALAOCAN City / Province: NUEVA VIZCAYA

HH No. No. of Children Check if: Check if: Fill in: Check if:
No. of <6 6-23 24-59 >60 Couple Toilet Water Food HH HH
HH mos. mos. mos. mos. Educational Practice Type WS, Source Production Using Using
Name of Household Occupation Mother EBF Mixed Bottle Others
Mem Old old old old Attainment Family OP, O, N P,W,S Activity VG, Iodized IFR
Pregnant Feeding Fed
bers planning P/L, FP Salt

F
M
F
M
F
M
F
M
F
M
F
M
F
M
F
M
F
M
F
M
F
M
F
M
F
M
F
M
Abbreviation
CF – Complimentary IFR – Iron Educational Attainment Toilet Water Source Food Production Activity
EBF_ Exclusive F – Father EU- Elem, Undergraduate CU- College Undergraduate WS- Water Sealed P- Pipe VG- Vegetable Garden
HH – Household M – Mother EG – Elem. Graduate CG – College Graduate OP – Open Pit W- Well P/L – Poultry / Livestock
HU – HS Graduate V- Vocational O- Others S- spring FP - Fishpond
HG – HS Graduate O- Others N- None