BNS Form No.

1A
Philippines Plan of Action for Nutrition
FAMILY PROFILE
Purok / Sitio: _______________ Municipality: ___________
Barangay : _________________ City / Province: ____________

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 Educational
mos. mos. mos. mos. Name of Household Occupation Mother Practice EBF Mixed Bottle Others Type WS, Source Production Using Using
Mem Attainment
Old old old old Pregnant Family Feeding Fed OP, O, N P,W,S Activity VG, Iodized IFR
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