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    Roland Artieda
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    This document contains reporting forms from a school-based iron folic acid supplementation program in the Philippines. It summarizes the enrollment numbers, number of students given and not given the supplements, and reasons for not being given the supplements for two reporting periods from July to September 2019. The forms are for Tigbauan National High School in Maasin, Iloilo and show that for most students, the reason for not being given the supplements was refusing to sign the consent form.

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    Original Title

    Wifa Report

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    This document contains reporting forms from a school-based iron folic acid supplementation program in the Philippines. It summarizes the enrollment numbers, number of students given and not given the supplements, and reasons for not being given the supplements for two reporting periods from July to September 2019. The forms are for Tigbauan National High School in Maasin, Iloilo and show that for most students, the reason for not being given the supplements was refusing to sign the consent form.

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    © All Rights Reserved
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    19 views9 pages

    Form 3 - District Level

    Uploaded by

    Roland Artieda
    This document contains reporting forms from a school-based iron folic acid supplementation program in the Philippines. It summarizes the enrollment numbers, number of students given and not given the supplements, and reasons for not being given the supplements for two reporting periods from July to September 2019. The forms are for Tigbauan National High School in Maasin, Iloilo and show that for most students, the reason for not being given the supplements was refusing to sign the consent form.

    Copyright:

    © All Rights Reserved
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    Flag for inappropriate content
    of 9

    Form 3 – District Level

    Annex A3
    School-based Weekly Iron Folic Acid (WIFA) Supplementation

    Round 1 Round 2 ̸ Reporting Month: July-September

    Grade Level 7 8 9 10 ALS

    School Year: 2017 – 2018 Date: 03-19-2018


    Region: VI Division: Iloilo District: Maasin_______

    Enrollment Given WIFA Supp. Not Given WIFA Supp. Remarks


    Total No. of
    Total No. of Total No. of Female
    (Reasons why WIFA is not
    School ID School Enrolled Female Learners Number % Number %
    given)
    Learners Learners with
    Consent
    Tigbauan NHS
    1)302579 128 63 31 31 49% 19 30% No consent
    Maasin

    Total 128 63 31 31 49% 19 30%

    Submitted by: Approved by:

    MYRABEL A. MIADO __________________________


    Clinic In-Charge District Supervisor

    Date: 03-19-2018 Validated By: ____________________________ Date: __________


    School Nurse

    ____________________________
    Form 4 – District Level
    Annex A4
    School-based Weekly Iron Folic Acid (WIFA) Supplementation

    Round 1 Round 2 ̸ Reporting Month: February-March

    Grade Level 7 8 9 10 ALS

    Region: VI Date: 03-19-2018


    Division: Iloilo

    Enrollment Given WIFA Supp. Not Given WIFA Supp. Remarks


    Total No. of
    Total No. of Total No. of Female
    District (Reasons why WIFA is not
    Enrolled Female Learners Number % Number %
    given)
    Learners Learners with
    Consent
    Maasin 128 63 31 31 49% 19 30% No consent

    Total 128 63 31 31 49% 19 30%

    Submitted by: Approved by:

    MYRABEL A. MIADO ____________________________________


    Clinic In-Charge Schools Division Supervisor/Superintendent

    Date Accomplished: 03-19-2018


    Validated by: ________________________________
    Division Nurse In-Charge
    Reporting Form 2a-Classroom level
    Annex A2

    School-based Weekly Iron Folic Acid (WIFA) Supplementation

    Round 1 Round 2 / Reporting Month: July-September 2019

    Grade Level 7 / 8 9 10 ALS


    /
    Region: VI Division: Iloilo Date: 10-01-2019____
    School ID: 302579_____ /
    Name of School: Tigbauan National High School Address: Tigbauan, Maasin, Iloilo

    Enrollment Given WIFA Supp. Not Given WIFA Supp. Remarks


    Total No. of
    Total No. of Total No. of Female
    Section (Reasons why WIFA is not
    Enrolled Female Learners Number % Number %
    given)
    Learners Learners with
    Consent
    1 41 16 15 15 94 1 6 Refuse to sign the consent

    Total 41 16 15 15 94 1 6

    Administered by: Noted:

    MYRABEL A. MIADO MARY JOY D. BEDOÑA


    Class Adviser Grade Level Teacher

    Date Started: July 8, 2019 Date Finished: September 30, 2019


    Reporting Form 2a-Classroom level
    Annex A2
    School-based Weekly Iron Folic Acid (WIFA) Supplementation

    Round 1 Round 2 / Reporting Month: July-September 2019

    Grade Level 7 8 ̸/ 9 10 ALS

    Region: VI Division: Iloilo Date: 10-01-2019


    School ID: 302579_____ Name of School: Tigbauan National High School Address: Tigbauan, Maasin, Iloilo

    Enrollment Given WIFA Supp. Not Given WIFA Supp. Remarks


    Total No. of
    Total No. of Total No. of Female
    Section (Reasons why WIFA is not
    Enrolled Female Learners Number % Number %
    given)
    Learners Learners with
    Consent
    1 41 20 19 19 95 1 5 Refuse to sign the consent

    Total 41 20 19 19 95 1 5

    Administered by: Noted:

    MARY JOY D. BEDOÑA MARY JOY D. BEDOÑA


    Class Adviser Grade Level Teacher

    Date Started: July 8, 2019 Date Finished: September 30, 2019


    Reporting Form 2a-Classroom level
    Annex A2

    School-based Weekly Iron Folic Acid (WIFA) Supplementation

    Round 1 Round 2 / Reporting Month: July-September 2019

    Grade Level 7 8 9 / 10 ALS


    /
    Region: VI Division: Iloilo Date: 10-01-2019___
    School ID: 302579_____ /
    Name of School: Tigbauan National High School Address: Tigbauan, Maasin, Iloilo
    /
    Enrollment Given WIFA Supp. Not Given WIFA Supp. Remarks
    Total No. of
    Total No. of Total No. of Female
    Section (Reasons why WIFA is not
    Enrolled Female Learners Number % Number %
    given)
    Learners Learners with
    Consent
    1 34 14 14 14 100 0 0

    Total 34 14 14 14 100 0 0

    Administered by: Noted:

    GERWAYNE M. PALOMAR MARY JOY D. BEDOÑA


    Class Adviser Grade Level Teacher

    Date Started: July 8, 2019 Date Finished: September 30, 2019


    Reporting Form 2a-Classroom level
    Annex A2

    School-based Weekly Iron Folic Acid (WIFA) Supplementation

    Round 1 Round 2 / Reporting Month: July-September 2019

    Grade Level 7 8 9 10 / ALS


    /
    Region: VI Division: Iloilo Date: 10-01-2019_____
    School ID: 302579_____ Name of School: Tigbauan National High School / Address: Tigbauan, Maasin, Iloilo
    /
    Enrollment Given WIFA Supp./ Not Given WIFA Supp. Remarks
    Total No. of /
    Total No. of Total No. of Female /
    Section (Reasons why WIFA is not
    Enrolled Female Learners Number %/ Number %
    given)
    Learners Learners with
    /
    Consent
    1 24 10 10 10 100/ 0 0
    /
    /
    /
    /
    /

    Total 24 10 10 10 100 0 0

    Administered by: Noted:

    JOENELLE M. ANZURES MARY JOY D. BEDOÑA


    Class Adviser Grade Level Teacher

    Date Started: July 8, 2019 Date Finished: September 30, 2019


    Reporting Form 2b-School Level
    Annex A2a
    School-based Weekly Iron Folic Acid (WIFA) Supplementation

    Round 1 Round 2 / Reporting Month: July-September2019

    Grade Level 7 8 9 10 ALS

    Region: VI Division: Iloilo Date: 10-01-2019_____


    School ID: 302579_____ Name of School: Tigbauan National High School Address: Tigbauan, Maasin, Iloilo

    Enrollment Given WIFA Supp. Not Given WIFA Supp. Remarks


    Total No. of
    Total No. of Total No. of Female
    Section (Reasons why WIFA is not
    Enrolled Female Learners Number % Number %
    given)
    Learners Learners with
    Consent
    7 41 16 15 15 94 1 6 (1) refuse to sign the consent
    8 41 20 19 19 95 1 5 (1)Refuse to sign the consent
    9 34 14 14 14 100 0 0
    10 24 10 10 10 100 0 0
    11 21 9 9 9 100 0 0
    12 9 7 6 6 86 1 14 (1)refuse to sign the consent

    Total 170 76 73 73 96 3 4
    Submitted by: Noted:

    GRACE P. MAROMA ___________________________


    School Principal District Supervisor

    Date:10-01-2019 Date: ______________________

    Validated by:
    ___________________________
    School Nurse
    Reporting Form 2a-Classroom level
    Annex A2

    School-based Weekly Iron Folic Acid (WIFA) Supplementation

    Round 1 Round 2 / Reporting Month: July-September2019

    Grade Level 7 8 9 10 11 12 √

    Region: VI Division: Iloilo Date: 10-01-2019


    School ID: 302579_____ Name of School: Tigbauan National High School Address: Tigbauan, Maasin, Iloilo

    Enrollment Given WIFA Supp. Not Given WIFA Supp. Remarks


    Total No. of
    Total No. of Total No. of Female
    Section (Reasons why WIFA is not
    Enrolled Female Learners Number % Number %
    given)
    Learners Learners with
    Consent
    1 9 7 6 6 86 1 14 Refuse to sign the consent

    Total 9 7 6 6 86 1 14

    Administered by: Noted:

    KARREN B. SUPLICO MARY JOY D. BEDOÑA


    Class Adviser Grade Level Teacher

    Date Started: July 8, 2019 Date Finished: September 30, 2019


    Reporting Form 2a-Classroom level
    Annex A2

    School-based Weekly Iron Folic Acid (WIFA) Supplementation

    Round 1 Round 2 / Reporting Month: July-September2019

    Grade Level 7 8 9 10 11 √ 12 √

    Region: VI Division: Iloilo Date: 10-01-2019


    School ID: 302579_____ Name of School: Tigbauan National High School Address: Tigbauan, Maasin, Iloilo

    Enrollment Given WIFA Supp. Not Given WIFA Supp. Remarks


    Total No. of
    Total No. of Total No. of Female
    Section (Reasons why WIFA is not
    Enrolled Female Learners Number % Number %
    given)
    Learners Learners with
    Consent
    1 21 9 9 9 100 0 0

    Total 21 9 9 9 100 0 0

    Administered by: Noted:

    RAIAN M. MASIADO MARY JOY D. BEDOÑA


    Class Adviser Grade Level Teacher

    Date Started: July 8, 2019 Date Finished: September 30,2019

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