Republic of the Philippines

Province of Masbate
CIty of Masbate
City Social Welfare & Development Office
Weight Monitoring Form
Name of DCC:
Name of CDW:
Barangay:
Nutritional Status
Before Feeding After 60 Days After Feeding

Date of Age in Weight Wasting Stunting Date of Age in Weight Wasting Stunting Date of Age in Weight Wasting Stunting
No. Name of Children Sex Birthdate Height Weight (Weight for (Height for Height Weight (Weight for (Height for Height Weight Remarks
Weighing Mos for Age Height) Age) Weighing Mos for Age Height) Age) Weighing Mos for Age (Weight for (Height for
Height) Age)

10

11

12

13

14

15

Legend:
Weight for Age: Height for Age Weight for Height
N - Normal N - Normal N - Normal
UW - Underweight S - Stunted W- Wasted
SUW - Severely Underweight SS- Severely Stunted SW - Severely Wasted
OW- Overweight T- Tall OW- Overweight
Obese Obese

Prepared by: Noted by:

KATRINA L. ORTICIO, RSW

CDW Acting CSWD Officer