Department of Social Welfare and Development

FO1-SFP-001
Field Office 1
REV 00 / 02-12-2020
Quezon Avenue, City of San Fernando, La Union 2500

MASTERLIST OF CHILDREN
City/Municipality of BURGOS Province of ILOCOS SUR
CY 2023
Name of Child Development Center:
Time of Feeding:
Location:
Barangay:
District:
AM/PM SESSION (Separate am and pm session masterlist)
No. ADDRESS NAME OF FULL NAME OF CHILD SEX DATE OF ACTUAL WEIGHT HEIGHT AGE IN NUTRITIONAL STATUS Summary Pantawid PWD (pls Child of
PARENTS/GUARDIAN (Surname, Given Name, MI) MONTHS Member (pls put a check Solo Parent
BIRTH (m/d/y) DATE (kg) (cm) Weight Weight Height for of specify RCCT
(Surname, Given Name, MI) WEIGHING mark) (pls put a
for Age for Height Age Undernou / 4p's or
check mark)
(m/d/y) rished MCCT and
indicate
Children reference
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 Number of Undernourished Children
Nutritional Status Legend: Prepared by: Noted by:
Weight for Age Height for Age Weight for Height
N - Normal N - Normal N - Normal
UW - Underweight St - Stunted W - Wasted ROSELIN ANTOLIN ATENDIDO
SUW - Severely Underweight Sst - Severely Stunted SW - Severely Wasted Name/Position City/Municipal Social Welfare and Development Officer
OW - Overweight T - Tall OW - Overweight
Ob - Obese
 Department of Social Welfare and Development
FO1-SFP-001
Field Office 1
REV 00 / 02-12-2020
Quezon Avenue, City of San Fernando, La Union 2500

MASTERLIST OF CHILDREN
City/Municipality of BURGOS Province of ILOCOS SUR
CY 2023 - 2024
Name of Child Development Center: POBLACION NORTE CHILD DEVELOPMENT CENTER
Time of Feeding:
Location:
Barangay: POBLACION NORTE
District: 2ND
AM/PM SESSION (Separate am and pm session masterlist)
No. ADDRESS NAME OF FULL NAME OF CHILD SEX DATE OF BIRTH ACTUAL DATE WEIGHT HEIGHT AGE IN NUTRITIONAL STATUS Summary of Pantawid PWD (pls Child of
MONTHS Member (pls
PARENTS/GUARDIAN (Surname, Given Name, MI) (m/d/y) WEIGHING (kg) (cm) Weight for Weight for Height for Undernouri specify RCCT /
put a check Solo Parent
(Surname, Given Name, MI) (m/d/y) Age Height Age shed 4p's or MCCT mark) (pls put a
Children and indicate check mark)
1 POBLACION NORTE, BURGOS, ILOCOS SUR ASUNCION, JOHN JACOB V. 04/28/2020 3 yrs old

2 PADUROS, BURGOS, ILOCOS SUR 03/29/2020 3 yrs old

BAJADO, SHYNHER
3 8/11/2019 4 yrs old
POBLACION NORTE, BURGOS, ILOCOS SUR BARLISO, RHYKER EIRON I.
4 07/21/2019 4 yrs old
POBLACION NORTE, BURGOS, ILOCOS SUR CASTRO, JIHYUN JACE Q.
5 01/17/2020 3 yrs old
POBLACION NORTE, BURGOS, ILOCOS SUR DUQUE, ZACK JARED T.
6 06/16/2019 4 yrs old
POBLACION NORTE, BURGOS, ILOCOS SUR ESCOBAR, ETHAN JOSEPH H.
7 03/27/2020 3 yrs old
POBLACION NORTE, BURGOS, ILOCOS SUR GOZE, COVI JEFF C.
8 08/29/2020 3 yrs old
POBLACION NORTE, BURGOS, ILOCOS SUR HIDALGO, AEL JACE
9 POBLACION NORTE, BURGOS, ILOCOS SUR JAVIER, WAYNE THEO 08/23/2020 3 yrs old
10 POBLACION NORTE, BURGOS, ILOCOS SUR MINA, REIVEN CLAY ASHER S. 08/23/2019 4 yrs old
11 POBLACION NORTE, BURGOS, ILOCOS SUR RABOY, ZAMIELLE BLAZE S. 07/28/2019 4 yrs old
12 POBLACION NORTE, BURGOS, ILOCOS SUR RICAÑA, PAUL ANGELO C. 11/26/2019 3 yrs old
13 POBLACION NORTE, BURGOS, ILOCOS SUR ABOSAICA, FATMAH P. 05/18/2019 4 yrs old
14 POBLACION NORTE, BURGOS, ILOCOS SUR FABORITO, ZABRIANE KAIRA 02/26/2020 3 yrs old
15 POBLACION NORTE, BURGOS, ILOCOS SUR LUCYA, QWYNN DEISHA B. 06/15/2020 3 yrs old
Total Number of Undernourished Children
Nutritional Status Legend: Prepared by: Noted by:
Weight for Age Height for Age Weight for Height
N - Normal N - Normal N - Normal
UW - Underweight St - Stunted W - Wasted REYLYN MARIE A. BALDO - CDW ROSELIN ANTOLIN ATENDIDO
SUW - Severely Underweight Sst - Severely Stunted SW - Severely Wasted Name/Position City/Municipal Social Welfare and Development Officer
OW - Overweight T - Tall OW - Overweight
Ob - Obese
 FO1-SFP-002
WEIGHT MONITORING FORM REV 00 / 02-12-2020

City/Municipality of ___________________ Province of ______________________

City/Municipal Social Welfare and Development Office
CY ____________

Name of DCC/SNP: _______________

Name of DCW/Volunteer: _____________
Location: __________________________

Baseline Endline Remarks

Name of Children Sex Date of Weighing Age in Height Weight Nutritional Status Date of Age in Height Weight Nutritional Status
No. (Surname, Given Name (m/d/y) Mos (cm) (kg) Weight for Weight for Height for Summary Weighing Mos (cm) (kg) Weight for Weight for Height for Summary
Middle Initial) Age Height Age of (m/d/y) Age Height Age of
Undernouri Undernouri
shed shed
Children Children

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
26
27
28
29
30
Total Number of Undernourished Children

Nutritional Status Legend: Prepared by: Noted by:

Weight for Age
N - Normal SUW: Severly Underweight
UW - Underweight
SUW - Severely Underweight Name/Position City/Municipal Social Welfare and Development Officer
OW - Overweight

Height for Age

N - Normal
St - Stunted
Sst - Severely Stunted
T - Tall

Weight for Height

N - Normal
W - Wasted
SW - Severely Wasted
OW - Overweight
Ob - Obese
 Department of Social Welfare and Development
Field Office 1
Quezon Avenue, City of San Fernando, La Union 2500

CONSOLIDATED NUTRITIONAL STATUS

City/Municipality of ___________________ Province of ______________________
CY ______________

Weight for Age Weight for Height

Normal Underweight Severely Underweight Overweight Normal Wasted Severely Wasted Overweight/Obese
Baseline No. of No. of Total % Share No. of No. of Total % Share No. of No. of Total % Share No. of No. of Total % Share No. of No. of Total % Share No. of No. of Total % Share No. of No. of Total % Share No. of
Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male

Endline

Height for Age TOTAL NUMBER OF UNDERNOURISHED CHILDREN

Normal Severely Stunted Stunted Tall
Baseline No. of No. of Total % Share No. of No. of Total % Share No. of No. of Total % Share No. of No. of Total % Share No. of No. of Total % Share
Male Female Male Female Male Female Male Female Male Female

Endline

Prepared by: Noted by:

Name/Position City/Municipal Social Welfare and Development Officer

 FO1-SFP-003
REV 00 / 02-12-2020

Overweight/Obese
No. of Total % Share
Female