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: CARAGA/ AGUSAN DEL SUR Period Covered:

Office Address:
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

Severely Pupils-at-Risk-of- Indigenous Indigent Last Mile
SDOs All Kinder Wasted Stunted Dropping-Out Schools (with TOTAL
Wasted (PARDOs) Peoples Learners less than 100)

0
0
0
0
0
0
0
0
0
TOTAL 0 0 0 0 0 0 0 0

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

SDOs All Kinder Severely Wasted Stunted
Pupils-at-Risk-of-
Dropping-Out
Indigenous Indigent Last Mile
Schools (with TOTAL
Wasted (PARDOs) Peoples Learners less than 100)

0
0
0
0
0
0
0
0
0
TOTAL 0 0 0 0 0 0 0 0

3. SBFP Coverage: Total Beneficiaries for Milk sourced from Commercial Sources

SDOs All Kinder Severely Wasted Stunted

Pupils-at-Risk-of-
Dropping-Out
Indigenous Indigent Last Mile
Schools (with TOTAL
Wasted (PARDOs) Peoples Learners less than 100)

0
0
0
0
0
0
0
0
0
TOTAL 0 0 0 0 0 0 0 0
Attachment 2

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

SDOs All Kinder Severely Wasted Stunted
Pupils-at-Risk-of-
Dropping-Out
Indigenous Indigent Last Mile
Schools (with TOTAL
Wasted (PARDOs) Peoples Learners less than 100)

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)

SDOs All Kinder Severely Wasted Stunted

Pupils-at-Risk-of-
Dropping-Out
Indigenous Indigent Last Mile
Schools (with TOTAL
Wasted (PARDOs) Peoples Learners less than 100)

0
0
0
0
0
0
0
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
Milky Bun
Fortified/Enriched Bread
Fruits / Fruit Products
Rootcrops
Vegetables
Nutripacks
Cereals/Grains

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:
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 ESSD Chief

Date:
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: Period Covered:

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

Severely Pupils-at-Risk-of- Indigenous Indigent Last Mile
Grade Level All Kinder Wasted Stunted Dropping-Out Schools (with TOTAL
Wasted (PARDOs) Peoples Learners less than 100)

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

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

Grade Level All Kinder Severely Wasted Stunted
Pupils-at-Risk-of-
Dropping-Out
Indigenous Indigent Last Mile
Schools (with TOTAL
Wasted (PARDOs) Peoples Learners less than 100)

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

Grade Level All Kinder Severely Wasted Stunted

Pupils-at-Risk-of-
Dropping-Out
Indigenous Indigent Last Mile
Schools (with TOTAL
Wasted (PARDOs) Peoples Learners less than 100)

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
Attachment 2

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

Grade Level All Kinder Severely Wasted Stunted
Pupils-at-Risk-of-
Dropping-Out
Indigenous Indigent Last Mile
Schools (with TOTAL
Wasted (PARDOs) Peoples Learners less than 100)

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

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

Severely Pupils-at-Risk-of- Indigenous Indigent Last Mile
Grade Level All Kinder Wasted Stunted Dropping-Out Schools (with TOTAL
Wasted (PARDOs) Peoples Learners less than 100)

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
Milky Bun
Fortified/Enriched Bread
Fruits / Fruit Products
Rootcrops
Vegetables
Nutripacks
Cereals/Grains

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%)

Total:
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:
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: CARAGA/ AGUSAN DEL SUR Period Covered: SY 2021-2022

School Name & ID: SAN ISIDRO ES/ 202159
School Address: SITIO SAN ISIDRO, CAUSWAGAN, TALACOGON, AGUSAN DEL SUR
School Telephone Number: NONE Mobile Number: 09078672245
Fax Number: NONE Email Address: NONE
Total Enrolment: 74 Total No. of T & NTP: 4T & 1NTP

A. ACCOMPLISHMENTS

1. SBFP Coverage: Primary Beneficiaries for Nutritious Food Products

Grade Level All Kinder Severely Wasted Wasted TOTAL

Kinder 9 9
Grade 1 6 5 11
Grade 2 3 2 5
Grade 3 0 2 2
Grade 4 0 7 7
Grade 5 0 1 1
Grade 6 0 0 0
SPED 0 0 0
Multigrade 0 0 0
TOTAL 9 17 35

2. SBFP Coverage: Secondary Beneficiaries for Nutritious Food Products

Pupils-at-Risk-of- Indigenous Last Mile Schools
Grade Level Stunted Dropping-Out Indigent Learners (with TOTAL
(PARDOs) Peoples less than 100)

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

3. SBFP Coverage: Primary Beneficiaries for Milk

Grade Level All Kinder Severely Wasted Wasted TOTAL

Kinder 9 9
Grade 1 6 5 11
Grade 2 3 2 5
Grade 3 0 2 2
Grade 4 0 7 7
Grade 5 0 1 1
Grade 6 0 0 0
SPED 0 0 0
Multigrade 0 0 0
TOTAL 0 9 17 35

4. SBFP Coverage: Secondary Beneficiaries for Milk

Pupils-at-Risk-of- Indigenous Last Mile Schools
Grade Level Stunted Dropping-Out Indigent Learners (with TOTAL
(PARDOs) Peoples less than 100)

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

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

a. Nutritious Food Products
Enutribun
Milky Bun /
Fortified/Enriched Bread
Fruits / Fruit Products /
Rootcrops
Vegetables /
Nutripacks
Cereals/Grains /

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%)

N/A

Total:
Attachment 2

B. DONATIONS/ RESOURCES GENERATED

(Add Additional Sheets, if needed)

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

Provision of vegetables to the Indigent parents 20 200

Giving of seedling to the parents 18 630

Continuity of Gulayan Sa Paaralan Program

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?

Helped in distributed the Nutribuns, NurtipBHW, Barangay Officials Improved the children's health and nutrition values and

Carabao Milk behavior.

Planted vegetables in School Reducing micronutrient deficiency and anemia and

increasing cognitive and academic performance and

contributing to gender equity to education.

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

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:

MARIFE JOY ESCOZA THELMA P. CRUZ

SBFP Coordinator School Head
Date: DECEMBER 1, 2021
 Attachment 2

SY 2021-2022

OGON, AGUSAN DEL SUR

09078672245
NONE
4T & 1NTP
 Attachment 2

Estimated Cost (if applicable)

200

630

D NUTRITION PROGRAMS/

Outcome: What is/are its important contribution to the

School-Based Feeding Program of the school?

Improved the children's health and nutrition values and

behavior.

Reducing micronutrient deficiency and anemia and

increasing cognitive and academic performance and

contributing to gender equity to education.

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)

ONS

Noted:

School Head