SBFP Form 1

Department of Education
Region ___

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

Division/Province: ______________________________________

Name of Principal : ____________________________________

City/ Municipality/Barangay : ____________________________

Name of Feeding Focal Person : _________________________

Name of School / School District : _________________________

Age

No.

Name

Sex

BMI

Date of
in
for 6
Weig Heig
Date of Birth
Weighing /
Years
y.o.
(MM/DD/YYY
Measuring
ht
ht
/
and
Y)
(MM/DD/YYYY
(Kg) (cm)
Mont
abov
)

hs

Nutritio
nal
Disabili
Ethnicity
Status
ty
(NS)

4Ps ID
Number

Name of
Parents

Prepared by:

Noted :

__________________________________
Feeding Focal Person

_____________________________________
School Principal / Officer-in-Charge

Beneficiary of
SBFP in
Previous Years
(yes or no)

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 ___

SCHOOL-BASED FEEDING PROGRAM (SBFP)

Division/Province: ______________________________________
City/ Municipality/Barangay : ____________________________
Name of School / School District : _________________________

Nutritional Status at Start of Feeding

Number of Undernourished
No. of
School Children by Grade
Severely
Level

Wasted

No. of
Wasted

ofBeneficiaries
Pupils
Ethnicity No.
4 Ps
who are

Total
beneficiaries
Beneficia
in previous
ries No. of Ethnic Ben.
No. of 4 Ps Ben.
years

Remarks

1. Kinder
2. Grade I
3. Grade II
4. Grade III
5. Grade IV
6. Grade V
7. Grade VI

Total
Prepared by:

Noted by:

______________________________________
SBFP DepEd Focal

_________________________________
Unit Chief

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 DepEdHNC

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 DepEdHNC

SBFP Form 3
Department of Education
Region ___

SCHOOL-BASED FEEDING PROGRAM (SBFP)

Division/Province: ______________________________________
School District/City/ Municipality : ____________________________

Name of Schools

BEIS ID No.

School Address

Prepared by:

Name of District
Total
Supervisors/
Name of Barangay
Contact Number Beneficiari
School Principal
es
or OICs

Noted by:

SBFP DepED Focal

Unit Chief

Note: This form shall be prepared by the DO, for final consolidation by the RO, for submission to DSWD-FO, copy furnished DepEd-HNC

SBFP Form 4
SCHOOL-BASED FEEDING PROGRAM

FOR THE MONTH OF SEPTEMBER , SY 2016-2017

Region: V
Division: LIGAO CITY
District: LIGAO SOUTH

NAME OF PUPIL

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22

School: TUPAS ELEMENTARY SCHOOL

4Ps
Beneficiary Beneficiary
(y or n)
of Previous
SBFP
(y or n)

Justine Calmante
John Lloyd Cogasa
Jairus Borromeo
Mia Adalin
Jomari Salomon
Joel Calmante
Mark Pincaro
Melvin Clete
Philip Penaflor
Justin Ros
Jessa Mae Borromeo
Jeann Hermoso
Julie Cogasa
May Padua
Kimberly Padua
Gellien Adalin
Judel Salomon
Jamve Bonita
Mary Joy Delluva
Jemmelyn Magalona
Arlene Clete
John Carlo Pagayonan

ACTUAL FEEDING

PRE FEEDING
Age
5
5
7.2
6.3
7.6
7.2
7
8.9
9.9
8.9
10
9
8.9
8.9
9
9
11
10
12
10
10
12

Ht

Sex
Birth Date
4/1/2011
3/3/2011
04/29/2009
03/26/2010
12/15/2008
04/20/2009
07/30/2008
07/21/2007
12/12/2006
10/20/2007
03/24/2006
6/3/2007
09/17/2007
7/23/2007
9/6/2007
07/19/2007
2/2/2005
1/8/2006
7/3/2004
5/5/2006
07/13/2005
03/26/2004

Nutritional Status
Wt
Date

cm
103.00
103.00
101.00
103.00
108.00
106.00
113.00
122.00
117.00
118.00
119.00
123.00
121.00
121.00
125.00
124.00
126.00
129.00
144.00
125.00
127.00
130.00

M
M
M
F
M
M
M
M
M
M
F
F
F
F
F
F
M
M
M
M
M
F

kg Taken
14
14.5
16
13.5
16.6
15
16.7
19
17
18
17
19
18
18
20
20
24.5
20
29.5
21
20
24.5

NS

Deworming
( ) or Date
(X) Taken 1

9 10 11 12 13 14 15 16 17 18 19 20

TOTAL:

Prepared by:
LEGEND
____________________________
SBFP Coordinator

A. Nutritional Status
For 6-19 y.o

For below 6 y.o

B. Deworming

D. Actual Feeding

SW - Severely wasted

SU - Severely underweight

( x ) - not dewormed

( ) - Present, served

W - Wasted

U - Underweight

( ) - dewormed

( A ) - Absent, not served

N - Normal

N - Normal

Ow - Overwieght

Ow - Overwieght

( ) - Present, served twice

O - Obese

Page 7

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

Page 8

SBFP Form 4
SCHOOL-BASED FEEDING PROGRAM

FOR THE MONTH OF OCTOBER , SY 2016-2017

Region: V
Division: LIGAO CITY
District: LIGAO SOUTH

School: TUPAS ELEMENTARY SCHOOL

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 53 54 55 56 57 58 59 60
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22

Justine Calmante
John Lloyd Cogasa
Jairus Borromeo
Mia Adalin
Jomari Salomon
Joel Calmante
Mark Pincaro
Melvin Clete
Philip Penaflor
Justin Ros
Jessa Mae Borromeo
Jeann Hermoso
Julie Cogasa
May Padua
Kimberly Padua
Gellien Adalin
Judel Salomon
Jamve Bonita
Mary Joy Delluva
Jemmelyn Magalona
Arlene Clete
John Carlo Pagayonan

TOTAL:

D. Actual Feeding
( ) - Present, served

Prepared by:

FEBIE R. ONESA
SBFP Coord

( A ) - Absent, not served

( ) - Present, served twice

page 2

SBFP Form 4
SCHOOL-BASED FEEDING PROGRAM

FOR THE MONTH OF ______________________ , SY _____________

Region ____________________________
Division ___________________________
District ___________________________

School: _____________________________________
Grade: __________ Section _____________________

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 95 96 97 98 99 100
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22

Justine Calmante
John Lloyd Cogasa
Jairus Borromeo
Mia Adalin
Jomari Salomon
Joel Calmante
Mark Pincaro
Melvin Clete
Philip Penaflor
Justin Ros
Jessa Mae Borromeo
Jeann Hermoso
Julie Cogasa
May Padua
Kimberly Padua
Gellien Adalin
Judel Salomon
Jamve Bonita
Mary Joy Delluva
Jemmelyn Magalona
Arlene Clete
John Carlo Pagayonan

TOTAL:

D. Actual Feeding
( ) - Present, served
( A ) - Absent, not served
( ) - Present, served twice

page 3

SBFP Form 4
SCHOOL-BASED FEEDING PROGRAM

FOR THE MONTH OF ______________________ , SY _____________

Region ____________________________
Division ___________________________
District ___________________________

School: _____________________________________
Grade: __________ Section _____________________

ACTUAL FEEDING
NAME OF PUPIL
101 102 ### 104 105 ### ### ### ### ### 111 112 113 114 115 116 117 118 119 120

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22

POST FEEDING
Nutritional Status
Ht
Wt Date
cm
kg Taken NS

ATTENDANCE
Days
Present

Feeding
Days

Percentage

(A)

(B)

(A/B)*100

Justine Calmante
John Lloyd Cogasa
Jairus Borromeo
Mia Adalin
Jomari Salomon
Joel Calmante
Mark Pincaro
Melvin Clete
Philip Penaflor
Justin Ros
Jessa Mae Borromeo
Jeann Hermoso
Julie Cogasa
May Padua
Kimberly Padua
Gellien Adalin
Judel Salomon
Jamve Bonita
Mary Joy Delluva
Jemmelyn Magalona
Arlene Clete
John Carlo Pagayonan

TOTAL:

AVERAGE:

D. Actual Feeding
( ) - Present, served
( A ) - Absent, not served
( ) - Present, served twice

page 4

page 4

SBFP Form 5
SCHOOL-BASED FEEDING PROGRAM

CONSOLIDATED NUTRITIONAL STATUS AND ATTENDANCE REPORT

Region: _______
Division/District: ________________________
School: ________________________________
BEIS ID No.: ___________________________
GRADES AND SECTIONS

No. of Pupils
Dewormed

NUTRITIONAL STATUS
SW/SU

W/U

BEFORE
N
Ow

Ob

Total

SW/SU

W/U

AFTER
N
Ow

Total

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

AVERAGE:

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

For below 6 y.o

SU - Severely Underweight
U - Underweight
N - Normal
Ow - Overweight

Prepared by:
_____________________________
Classroom Adviser / School Nurse

Noted by:

Note: This form shall be prepared by the school using the data from SBFP Form 4.

___________________________
School Head

PERCENTAGE
ATTENDANCE