SBFP Form 1

Department of Education
Region XI

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

Division/Province : Division of Davao City Name of Principal : ____________________________________

City/ Municipality/Barangay : ______________________________ Name of Feeding Focal Person : _________________________
School District / Name of School : _________________________
School ID Number : _____________________________________

BMI for Beneficiary of SBFP

Grade/ Date of Weighing / Age in Weight Height 6 y.o. Nutritional Participation in
Date of Birth
No. Name Sex Measuring Years / Name of Parents in Previous Years
Section (MM/DD/YYYY)
(MM/DD/YYYY) Months (Kg) (cm) and Status (NS) 4Ps (yes or no)
above (yes or no)

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20

Prepared by: Noted :

__________________________________ _____________________________________
Feeding Focal Person School Principal / Officer-in-Charge

Note: This form shall be prepared by the school, to be compiled by the DO, and for final compilation by the RO, for submission to DSWD-FO, copy furnished DepEd-HNC
SBFP Form 2
Department of Education
Region XI

SCHOOL-BASED FEEDING PROGRAM (SBFP)

Division/Province: Davao City

School District : ____________________________

Name of District Supervisors/

Name of School BEIS ID No. School Address Name of Barangay School Principal or OICs /
Feeding Coordinator

District Supervisor

Principal

Feeding Coordinator

Prepared by: Noted by:

School Feeding Coordinator School Principal

 Total
Contact Number Beneficiarie
s
SBFP Form 3
Department of Education
Region XI

SCHOOL-BASED FEEDING PROGRAM (SBFP) SUMMARY OF BENEFICIARIES & START OF FEEDING

Division/Province: Davao City
City/ Municipality/Barangay : ____________________________
School District / Name of School : _______________________
School ID Number : ___________________________________
Date of Start of Feeding : ______________________________

Nutritional Status at Start of Feeding

No. of 4 Ps No. of Pupils who are
Number of Undernourished School
No. of Severely beneficiaries in previous
Children by Grade Level
No. of Wasted Total Beneficiaries Beneficiaries years
Wasted

1. Kinder 0

2. Grade I 0

3. Grade II 0

4. Grade III 0

5. Grade IV 0

6. Grade V 0

7. Grade VI 0

8. SPED 0

Total 0 0 0 0 0

Prepared by: Noted by:

______________________________________ _________________________________
School Based Feeding Coordinator School Principal

Note: This form shall be prepared by the school, to be compiled by the SDO, and for final compilation by the RO, for submission to DepEd BLSS-SHD
Remarks

0
 SBFP Form 4
SCHOOL-BASED FEEDING PROGRAM
RECORD OF DAILY FEEDING
FOR THE MONTH OF ______________________ , SY 2018 - 2019
Region XI
Division Davao City School: _____________________________________
District ___________________________ School ID Number: ______________________

ACTUAL FEEDING
Beneficiary PRE FEEDING
4Ps
of Previous
NAME OF PUPIL Beneficiary
SBFP Nutritional Status Deworming
(y or n) Ht Wt Date Date
(y or n) Age Birth Date Sex (√ ) or
NS
cm kg Taken (X) Taken 1 2 3 4 5 6 7 8 9 10 11 12
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:
Prepared by:
LEGEND
_________________________________ A. Nutritional Status
B. Deworming D. Actual Feeding
School Feeding Coordinator For 6-19 y.o For below 6 y.o
SW - Severely wasted SU - Severely underweight ( x ) - not dewormed ( √ ) - Present, served
W - Wasted U - Underweight ( √ ) - dewormed ( A ) - Absent, not served
N - Normal N - Normal (√√ ) - Present, served twice
Ow - Overwieght Ow - Overwieght
O - Obese

Note: This form shall be prepared by the school to be consolidated using SBFP Form 5
Page 6
___________

L FEEDING

13 14 15 16 17 18 19 20

tual Feeding

ed
erved
ed twice

Page 7
 SBFP Form 4

SCHOOL-BASED FEEDING PROGRAM

FOR THE MONTH OF ______________________ , SY 2018 - 2019

Region XI District ___________________________

Division Davao City School ID Number: ______________________
District ___________________________

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 50 51 52
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:

D. A
( √ ) - Present,
( A ) - Absent, n
(√√ ) - Present,
page 2
 53 54 55 56 57 58 59 60

D. Actual Feeding
( √ ) - Present, served
( A ) - Absent, not served
(√√ ) - Present, served twice
page 2
 SBFP Form 4

SCHOOL-BASED FEEDING PROGRAM

FOR THE MONTH OF ______________________ , SY 2018 - 2019

Region XI District ___________________________

Division Davao City School ID Number: ______________________
District ___________________________

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 91 92 93 94
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:

D. Actual Feeding

( √ ) - Present, served
( A ) - Absent, not served
(√√ ) - Present, served twice

page 3
95 96 97 98 99 100

page 3
 SBFP Form 4

SCHOOL-BASED FEEDING PROGRAM

FOR THE MONTH OF ______________________ , SY 2018-2019
Region ____________________________
Division ___________________________ School: _____________________________________
District ___________________________ Grade: __________ Section _____________________

ACTUAL FEEDING POST FEEDING

NAME OF PUPIL Nutritional Status

Ht Wt Date
101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 cm kg Taken NS
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:

D. Actual Feeding

( √ ) - Present, served
( A ) - Absent, not served
(√√ ) - Present, served twice

page 4
 ATTENDANCE
Days Feeding
Percentage
Present Days
(A) (B) (A/B)*100

AVERAGE:

page 4
SBFP Form 5
SCHOOL-BASED FEEDING PROGRAM
SY 2018 - 2019
CONSOLIDATED NUTRITIONAL STATUS AND ATTENDANCE REPORT
Period Covered: JULY 2019 - SEPTEMBER 2019
Region: XI
Division: DEP- ED DAVAO CITY
District: DAVAO CENTRAL
School: WIRELESS ELEMENTARY SCHOOL

NUTRITIONAL STATUS
BEFORE (BASELINE) AFTER 40 DAYS
Total No. of No. of 4P's No. of Pupils
GRADE LEVEL
Beneficiaries Beneficiaries Dewormed
SW/SU % W/U % N % Ow % Ob % Total % SW/SU % W/U % N % Ow %

1 KINDER 41 0 41 13 32% 28 68% 0 0% 0 0% 0 0% 41 100% 9 22% 25 61% 7 17% 0 0%

2 GRADE I 13 0 13 8 62% 5 38% 0 0% 0 0% 0 0% 13 100% 4 31% 5 38% 4 31% 0 0%

3 GRADE II 31 0 31 12 39% 19 61% 0 0% 0 0% 0 0% 31 100% 8 26% 17 55% 6 19% 0 0%

4 GRADE III 18 2 18 6 33% 12 67% 0 0% 0 0% 0 0% 18 100% 4 22% 10 56% 4 22% 0 0%

5 GRADE IV 16 2 16 8 50% 8 50% 0 0% 0 0% 0 0% 16 100% 6 38% 5 31% 5 31% 0 0%

6 GRADE V 36 0 36 25 69% 11 31% 0 0% 0 0% 0 0% 36 100% 12 33% 17 47% 7 19% 0 0%

7 GRADE VI 20 0 20 9 45% 11 55% 0 0% 0 0% 0 0% 20 100% 5 25% 9 45% 6 30% 0 0%

8 SPED 0 0 0 0 ### 0 ### 0 ### 0 ### 0 ### 0 ### 0 ### 0 ### 0 ### 0 ###
TOTAL 175 4 175 81 46% 94 54% 0 0% 0 0% 0 0% 175 100% 48 27% 88 50% 39 22% 0 0%

Legend:
For 6-19 y.o For below 6 y.o
SW - Severely Wasted SU - Severely Underweight
W - Wasted U - Underweight
N - Normal N - Normal
Ow - Overweight Ow - Overweight
O - Obese

Prepared by: Noted by:

ZANDRA F. ONTAL ELOISA R. QUESTO

School Feeding Coordinator School Principal
YS
PERCENTAGE
ATTENDANCE
Ob % Total %

0 0% 41 100% 96%

0 0% 13 100% 97%

0 0% 31 100% 98%

0 0% 18 100% 97%

0 0% 16 100% 98%

0 0% 36 100% 98%

0 0% 20 100% 98%

0 ### 0 ### 0%
0 0% 175 100% 97%