Republic of the Philippines

Dmpartment of Education
Negros Island Region
GUIHULNGAN CITY DIVISION

NUTRITIONAL STATUS RECORD

District: ____________________________
School: ____________________________
Grade & Section:____________________
Date of Weighing:___________________

Age of Weight Height Body

No. Name Birthday Date of (in Kg) (in meters) Mass NS
Weighing Index

BODY MASS INDEX ( BMI )

Grade Enrolment Pupils Weight Severely Wasted Normal Overweight Obese
Level Wasted
No. % No. % No. % No. % No. % No. %
Male
Female
Total

Prepared by: Noted:

___________________________________ __________________________________
Adviser School Head