SBFP Form 1 Annex 1

Department of Education
Region IV A

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

SY 2019-2020
Division/Province: RIZAL Name of Principal : JOCELYN D. VALERIO
City/ Municipality/Barangay : BARAS Name of Feeding Focal Person : DIVINA T. MARANAN
Name of School / School District : BARAS-PINUGAY PHASE 2 NATIONAL HIGH SCHOOL

Date of Weighing BMI for 6 Beneficiary of SBFP

No. Name Sex Grade/ Date of Birth / Measuring
Age in Years / Weight Height y.o. and
Nutritional Participation in Name of Parents in Previous Years
Section (MM/DD/YYYY)
(MM/DD/YYYY) Months (Kg) (cm) above Status (NS) 4Ps (Yes or No) (yes or no)

10

11

12

13

14

15
Prepared by: Noted :

DIVINA T. MARANAN JOCELYN D. VALERIO

Feeding Focal Person School Principal / Officer-in-Charge

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 DepEd BLSS-SHD
SBFP Form 3 Annex 3
Department of Education
Region ___

SCHOOL-BASED FEEDING PROGRAM (SBFP) SUMMARY OF BENEFICIARIES & START OF FEEDING

Division/Province: ______________________________________
City/ Municipality/Barangay : ____________________________
Name of School / School District : _________________________
School ID Number : _____________________________________
Date of Start of Feeding: _________________________________

Nutritional Status at Start of Feeding Ethnicity 4 Ps Beneficiaries

Number of Undernourished School
Children by Grade Level No. of No. of Pupils who
Severely No. of Total No. of 4Ps are beneficiaries in
Wasted Wasted Beneficiaries Beneficiaries previous 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:

______________________________________ _________________________________
 SBFP DepEd Focal

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 DedEd BLSS-SHD
SBFP Form 2 Annex 2
Department of Education
Region ___

SCHOOL-BASED FEEDING PROGRAM (SBFP) LIST OF SCHOOLS

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

Name of District
Total
Name of Schools BEIS ID No. School Address Name of Barangay Supervisors/ Contact Number
Beneficiaries
School Principal or OICs

Prepared by: 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 BLSS-SHD
 SBFP Form 4 Annex 4

SCHOOL-BASED FEEDING PROGRAM

FOR THE MONTH OF JULY , SY 2019-2020

Region ____________________________ IV-A
Division ___________________________ RIZAL School: _____ BARAS-PINUGAY PHASE 2 NHS
District ___________________________ BARAS Grade: __________ Section _____________________
School ID Number: __ 304798

ACTUAL FEEDING
PRE FEEDING
4Ps
NAME OF STUDENTS Beneficiary Beneficiary Nutritional Status Deworming
(y or n) of Previous Ht Wt Date
SBFP
Age Birth Sex (√ ) or Date
NS
(y or n) Date cm kg Taken (X) Taken 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
TOTAL:
Prepared by:
LEGEND
DIVINA T. MARANAN A. Nutritional Status
B. Deworming D. Actual Feeding
Feeding Teacher / School Nurse For 6-19 y.o For below 6 y.o
SW - Severely wasted SU - Severely underweight ( x ) - not dewormed ( √ ) - Present, served
W - Wasted U - Underweight ( √ ) - dewormed ( A ) - Absent, not served
N - Normal N - Normal (√√ ) - Present, served twice
Ow - Overwieght Ow - Overwieght
O - Obese

Page 6
Note: This form shall be prepared by the school to be consolidated using SBFP Form 5

Page 7
 SBFP Form 4

SCHOOL-BASED FEEDING PROGRAM

FOR THE MONTH OF ______________________ , SY _____________

Region ____________________________
Division ___________________________ School: _____________________________________
District ___________________________ Grade: __________ Section _____________________

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
23
24
25
TOTAL:

D. Actual Feeding

( √ ) - Present, served
( A ) - Absent, not served
(√√ ) - Present, served twice

page 2
 SBFP Form 4

SCHOOL-BASED FEEDING PROGRAM

FOR THE MONTH OF ______________________ , SY _____________

Region ____________________________
Division ___________________________ School: _____________________________________
District ___________________________ 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
23
24
25
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 ___________________________ School: _____________________________________
District ___________________________ Grade: __________ Section _____________________

ACTUAL FEEDING POST FEEDING

ATTENDANCE
NAME OF PUPIL Nutritional Status Days Feeding
Percentage
Ht Wt Date Present Days
### 102 ### ### 105 ### ### ### ### ### ### 112 113 114 115 116 117 118 119 120 cm kg Taken NS (A) (B) (A/B)*100
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
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.: ___________________________
NUTRITIONAL STATUS
No. of Pupils BEFORE AFTER PERCENTAGE
GRADES AND SECTIONS
Dewormed ATTENDANCE
SW/SU W/U N Ow Ob Total SW/SU W/U N Ow O 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 For below 6 y.o
SW - Severely Wasted SU - Severely Underweight
W - Wasted U - Underweight
N - Normal N - Normal
Ow - Overweight Ow - Overweight
O - Obese
Prepared by: Noted by:
_____________________________ ___________________________
Classroom Adviser / School Nurse School Head

Note: This form shall be prepared by the school using the data from SBFP Form 4.
 SBFP Form 6-C
SCHOOL-BAS

Region : IV-A Division: RIZAL

District: BARAS
School: BARAS-PINUGAY PHASE 2 NATIONAL HIGH SCHOOL
Before Feeding
No. Of
Grade Level ENROLLMENT Beneficiaries % SW % W % N %
 SCHOOL-BASED FEEDINGCONSOLIDATED PROGRAM TERMINAL REPORT-CONSOLIDATED NUTRTIONAL STATUS
SY 2019-2020

Before Feeding Midline (after 60 days of feeding)

OW % OB % TOTAL SW % W % N % OW
D NUTRTIONAL STATUS

ays of feeding) After Feeding

% OB % TOTAL SW % W % N % OW %
OB % TOTAL