Attachment 2

Document Code:
Quality Form
Revision:
OK sa DepEd - School-Based Feeding Program (SBFP)
Program Terminal Report Form Effectivity date: 01-1-2021

(SBFP PTR - Form C) BLSS-School Health Division

Region/Division: V Masbate Province Period Covered: SY: 2019-2020

Office Address: RODEO ROAD, MASBATE CITY,MASBATE
Office Telephone Number: Mobile Number:
Fax Number: Email Address:
Number of Schools in the Region: Elementary Enrolment:
Secondary Enrolment:
TOTAL:
A. ACCOMPLISHMENTS

1. SBFP Coverage: Total Beneficiaries for Nutritious Food Products

Pupils-at-Risk-
Severely Indigenous Indigent
SDOs All Kinder Wasted Stunted of-Dropping- TOTAL
Wasted Peoples Learners
Out (PARDOs)
kinder 19,120 0 0 19120
Grade I 1,166 3670 4836
Grade II 987 3045 4032
Grade III 819 2653 3472
Grade IV 619 2247 2866
Grade V 846 2352 3198
Grade VI 598 2415 3013
Sped 1 24 25
0
TOTAL 19120 5036 16406 0 0 0 0 40562

2. SBFP Coverage: Total Beneficiaries for Milk sourced from NDA/PCC

Severely Pupils-at-Risk- Indigenous Indigent
SDOs All Kinder Wasted Stunted of-Dropping- TOTAL
Wasted Peoples Learners
Out (PARDOs)
Kinder
Grade I
Grade II
Grade III
Grade IV
Grade V
Grade VI
Sped

TOTAL

3. SBFP Coverage: Total Beneficiaries for Milk sourced from Commercial Sources
Severely Pupils-at-Risk- Indigenous Indigent
SDOs All Kinder Wasted Stunted of-Dropping- TOTAL
Wasted Peoples Learners
Out (PARDOs)
Kinder 0
Grade I 0
Grade II 0
Grade III 0
Grade IV 0
Grade V 0
Grade VI 0
Sped 0
0

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Attachment 2
TOTAL 0 0 0 0 0 0 0 0

4. SBFP Coverage: Total Beneficiaries for Milk Donated by Partners

Pupils-at-Risk-
SDOs All Kinder Severely Wasted Stunted of-Dropping- Indigenous Indigent TOTAL
Wasted Out (PARDOs) Peoples Learners
0
0
0
0
0
0
0
0
0
TOTAL 0 0 0 0 0 0 0 0

5. SBFP Coverage: Grand Total Beneficiaries for Milk (All sources)

Severely Pupils-at-Risk- Indigenous Indigent
SDOs All Kinder Wasted Wasted Stunted of-Dropping- Peoples Learners TOTAL
Out (PARDOs)
Kinder 0
Grade I 0
Grade II 0
Grade III 0
Grade IV 0
Grade V 0
Grade VI 0
Sped 0
0
TOTAL 0 0 0 0 0 0 0 0

6. Type of Food Commodities Distributed to Learners (Check applicable items)

a. Nutritious Food Products
Enutribun
Fortified/Enriched Bread /
Fruits /
Rootcrops
Vegetables
Nutripacks

b. Milk
Fresh Milk
Sterilized Milk
Commercial Milk
Provided by Partner

7. SBFP Funds (for those with downloaded funds)

Amount Received from CO Funds Utilized Percent Utilization
(col 3/2*100%)

NFP
Milk
PSF
Additional Funds
Total:

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Attachment 2
B. DONATIONS/ RESOURCES GENERATED
(Add Additional Sheets, if needed)

Partner & Type of Donations/Services Provided Quantity (if applicable) Estimated Cost (if applicable)

C. SIGNIFICANT EVENTS OF SBFP, AND OTHER HEALTH AND NUTRITION PROGRAMS/

EXPERIENCES/ GOOD PRACTICES
(Add Additional Sheets, if needed)
What happened? Who were involved? When Outcome: What is/are its important contribution to the
School-Based Feeding Program of the school?

D. LESSONS LEARNED G. SUGGESTIONS TO STRENGTHEN SBFP (Include support

needed from Central, Region, and Division Office that can increase the impact of OK
sa DepEd Program in the schools)

E. PROPOSED PLAN OF ACTION AND RECOMMENDATIONS

F. PHOTOS (Before, During and After)

Prepared by: Noted:

SBFP Coordinator Schools Division Superintendent

Date:

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Attachment 2
Document Code:
Quality Form
Revision:
OK sa DepEd - School-Based Feeding Program (SBFP)
Program Terminal Report Form Effectivity date: 01-1-2021

(SBFP PTR - Form B) BLSS-School Health Division

Region/Division: V- MASBATE PROVINCE Period Covered: SY:2020-2021

Office Address:
Office Telephone Number: Mobile Number:
Fax Number: Email Address:
Number of Schools in the Schools Division: Elementary Enrolment:
Secondary Enrolment:
TOTAL:
A. ACCOMPLISHMENTS

1. SBFP Coverage: Total Beneficiaries for Nutritious Food Products

Pupils-at-Risk-
Severely Indigenous Indigent
Grade Level All Kinder Wasted Stunted of-Dropping- TOTAL
Wasted Peoples Learners
Out (PARDOs)
Kinder 0
Grade 1 0
Grade 2 0
Grade 3 0
Grade 4 0
Grade 5 0
Grade 6 0
SPED 0
Multigrade 0
TOTAL 0 0

2. SBFP Coverage: Total Beneficiaries for Milk sourced from NDA/PCC

Severely Pupils-at-Risk- Indigenous Indigent
Grade Level All Kinder Wasted Wasted Stunted of-Dropping- Peoples Learners TOTAL
Out (PARDOs)
Kinder 0
Grade 1 0
Grade 2 0
Grade 3 0
Grade 4 0
Grade 5 0
Grade 6 0
SPED 0
Multigrade 0
TOTAL 0 0 0 0 0 0 0 0

3. SBFP Coverage: Total Beneficiaries for Milk sourced from Commercial Sources
Pupils-at-Risk-
Severely of-Dropping- Indigenous Indigent
Grade Level All Kinder Wasted Stunted TOTAL
Wasted Out (PARDOs) Peoples Learners

Kinder 0
Grade 1 0
Grade 2 0
Grade 3 0
Grade 4 0
Grade 5 0
Grade 6 0
SPED 0
Multigrade 0
TOTAL 0 0 0 0 0

4. SBFP Coverage: Total Beneficiaries for Milk Donated by Partners

Pupils-at-Risk-
Severely Indigenous Indigent
Grade Level All Kinder Wasted Stunted of-Dropping- TOTAL
Wasted Peoples Learners
Out (PARDOs)
Kinder 0
Grade 1 0
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Attachment 2
Grade 2 0
Grade 3 0
Grade 4 0
Grade 5 0
Grade 6 0
SPED 0
Multigrade 0
TOTAL 0 0 0 0 0 0 0 0

5. SBFP Coverage: Grand Total Beneficiaries for Milk (All sources)

Pupils-at-Risk-
Severely Indigenous Indigent
Grade Level All Kinder Wasted Stunted of-Dropping- TOTAL
Wasted Peoples Learners
Out (PARDOs)
Kinder 0
Grade 1 0
Grade 2 0
Grade 3 0
Grade 4 0
Grade 5 0
Grade 6 0
SPED 0
Multigrade 0
TOTAL 0 0 0 0 0 0 0 0

6. Type of Food Commodities Distributed to Learners (Check applicable items)

a. Nutritious Food Products
Enutribun
Fortified/Enriched Bread /
Fruits /
Rootcrops
Vegetables
Nutripacks

b. Milk
Fresh Milk
Sterilized Milk
Commercial Milk
Provided by Partner

7. SBFP Funds (for those with downloaded funds)

Tranches Amount Received from RO Funds Utilized Percent Utilization
(col 3/2*100%)

NFP
Milk
PSF
Additional Fund
Total:

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 Attachment 2
B. DONATIONS/ RESOURCES GENERATED
(Add Additional Sheets, if needed)

Partner & Type of Donations/Services Provided Quantity (if applicable) Estimated Cost (if applicable)

C. SIGNIFICANT EVENTS OF SBFP, AND OTHER HEALTH AND NUTRITION PROGRAMS/

EXPERIENCES/ GOOD PRACTICES
(Add Additional Sheets, if needed)
What happened? Who were involved? When Outcome: What is/are its important contribution to the
School-Based Feeding Program of the school?

D. LESSONS LEARNED G. SUGGESTIONS TO STRENGTHEN SBFP (Include support

needed from Central, Region, and Division Office that can increase the impact of OK
sa DepEd Program in the schools)

program implementation, the school staff and the school health section exerted
Additional
additional
training/seminars/orientation
efforts to deliver the program
should
to the
be beneficiaries
provided to the
successfully.
program emplementers at school level.

E. PROPOSED PLAN OF ACTION AND RECOMMENDATIONS

*trainings/orientations/seminars will be provided to the program emplementers, re-orientation of parents regarding the program will also be
conducted. * Technical support will be provided to schools for faster processing and release of funds to
ensure early implementation of program.

F. PHOTOS (Before, During and After)

Prepared by: Noted:

SBFP Coordinator Schools Division Superintendent

Date:

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Attachment 2
Document Code:
Quality Form
Revision:
OK sa DepEd - School-Based Feeding Program (SBFP)
Program Terminal Report Form Effectivity date: 01-01-2021

(SBFP PTR - Form A) BLSS-School Health Division

Region/Division: V-MASBATE PROVINCE Period Covered:

School Name & ID: LOMOCLOC E/S - 113744
School Address: LOMOCLOC MOBO, MASBATE
School Telephone Number: Mobile Number:
Fax Number: Email Address:
Total Enrolment: 132 Total No. of T & NTP:

A. ACCOMPLISHMENTS

1. SBFP Coverage: Primary Beneficiaries for Nutritious Food Products

Grade Level All Kinder Severely Wasted Wasted TOTAL

Kinder 15 15
Grade 1 1 4 5
Grade 2 1 4 5
Grade 3 3 3
Grade 4 1 1
Grade 5 4 1 5
Grade 6 1 1 2
SPED 0
Multigrade 0
TOTAL 15 7 14 36

2. SBFP Coverage: Secondary Beneficiaries for Nutritious Food Products

Pupils-at-Risk-of-
Grade Level Stunted Dropping-Out Indigenous Peoples Indigent Learners TOTAL
(PARDOs)
Kinder 0
Grade 1 0
Grade 2 0
Grade 3 0
Grade 4 0
Grade 5 0
Grade 6 0
SPED 0
Multigrade 0
TOTAL 0 0 0 0 0

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Attachment 2

3. SBFP Coverage: Primary Beneficiaries for Milk

Grade Level All Kinder Severely Wasted Wasted TOTAL

Kinder 15 15
Grade 1 1 4 5
Grade 2 1 4 5
Grade 3 3 3
Grade 4 1 1
Grade 5 4 1 5
Grade 6 1 1 2
SPED 0
Multigrade 0
TOTAL 15 7 14 36

4. SBFP Coverage: Secondary Beneficiaries for Milk

Pupils-at-Risk-of-
Grade Level Stunted Dropping-Out Indigenous Peoples Indigent Learners TOTAL
(PARDOs)
Kinder 0
Grade 1 0
Grade 2 0
Grade 3 0
Grade 4 0
Grade 5 0
Grade 6 0
SPED 0
Multigrade 0
TOTAL 0 0 0 0 0

5. Type of Food Commodities Distributed to Learners (Check applicable items)

a. Nutritious Food Products
Enutribun
Fortified/Enriched Bread
Fruits
Rootcrops
Vegetables
Nutripacks

b. Milk
Fresh Milk
Sterilized Milk
Commercial Milk
Provided by Partner

6. SBFP Funds (for those with downloaded funds)

Tranches Amount Received from SDO Funds Utilized Percent Utilization
(col 3/2*100%)

Total:

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Attachment 2

B. DONATIONS/ RESOURCES GENERATED

(Add Additional Sheets, if needed)

Partner & Type of Donations/Services Provided Quantity (if applicable) Estimated Cost (if applicable)

C. SIGNIFICANT EVENTS OF SBFP, AND OTHER HEALTH AND NUTRITION PROGRAMS/

EXPERIENCES/ GOOD PRACTICES
(Add Additional Sheets, if needed)
What happened? Who were involved? When Outcome: What is/are its important contribution to the
School-Based Feeding Program of the school?

Conduct an orientation to the Parents/ Guardian SBFP aims to the rehabilitate severely wasted children

parents of the SBFP beneficiaries School Head, SBFP Coordinator by bringing them to normal nutrition status,enhancing

the value of holistic help and behavior of every

learner.

D. LESSONS LEARNED-Observing health protocol G. SUGGESTIONS TO STRENGTHEN SBFP (Include support

needed from Central, Region, and Division Office that can increase the impact of OK
sa DepEd Program in the schools)

wearing of mask, social distancing, wearing of face mask

E. PROPOSED PLAN OF ACTION AND RECOMMENDATIONS

F. PHOTOS (Before, During and After)

Prepared by: Noted:

MARITES R. DELA CRUZ CALVIN A. DILAO JR.

SBFP Coordinator School Head
Date:

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