SFP Form 2.

a
Submit 3 Copies
Total No. of Children should be based on Project Proposal
2-5 Years Old Only
DEPARTMENT OF SOCIAL WELFARE AND DEVELOPPMENT
Supplementary Feeding Program
MASTERLIST OF BENEFECIARIES
Name of CDC __Anito, Child Development Center_ Date of Weighing: _________________
Name of DCW __LANIE P. LAODENIO____________
Location __Brgy. Anito, Gamay N. Samar____

SEX BIRTHDATE AGE HEIGHT WEIGHT NUTRITIONAL ETHNICITY DISABILITY NAME OF PARENTS
NAME OF CHILDREN (YEAR/MONTH/DAY) (IN MOS.) (IN CM.) (IN KILOS) STATUS

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This form shall be used every month in recording weight and height of the child to determine the improvement in child’s nutritional status
*DCW should indicate date or month and year when the child was dewormed and provided Vit.A

Nutritional Status;
SU- Severely Underweight:_________________ PREPARED BY: REVIEWED BY: APPROVED BY:
UW- Underweight:________________________
N- Normal:______________________________ _____LANIE P. LAODENIO ____ ____LAILANY B. NICERIO________ _________DR. TIMOTEO T. CAPOQUIAN JR.____ ______________________________
OW- Overweight:_________________________ Child Development Worker MSWDO Municipal Mayor Date
 Republic of the Philippines
Province of Northern Samar
MUNICIPALITY OF GAMAY
Office of Social Welfare & Development

ACOMPLISHMENT REPORT FOR THE MONTH OF________________________2019

DATE ACTIVITIES OUTPUT REMARKS CHALENGES

PREPARED BY: REVIEWED BY:

_____ LANIE P. LAODENIO __________ ___LAILANY B. NICERIO________

Child Development Worker MSWDO