Professional Documents
Culture Documents
Quarterly Weighing
Quarterly Weighing
City/Municipality: _______________________
Province: _________________________________
48
24-59 Months
CY 20____
M O N T H OF W E I G H I N G
Date of Birth
3rd Quarter 4th Quarter
No. Name Sex
Date of Age Wt. Ht. Weight Height Weight Date of Age Wt. Ht. Weight Height Weight
Yr. Mo. Day for age for age for for age for age for
weighing weighing
(Mos.) (kgs.) (cms) status status height (mos) (kgs.) (cms) status status height
Summary: New: ________Total Weighed: ________ New: _______Total Weighed: ________
Old: ________ Old: ________
Nutritional Status: UW: ________ N: _________ UW: ________ N: _________
WEIGHT
FOR AGE SUW: ________ OW: _________ SUW: ________ OW: _________
Nutritional Status: St: ____________ N:__________ St: ____________ N:__________
HEIGHT FOR AGE Sst:___________ T:___________ Sst:___________ T:___________
Nutritional Status: W:_____________ N:______ Ob:______ W:_____________ N:______ Ob:______
WEIGHT FOR LENGTH SW:___________ OW:_____ SW:___________ OW:_____
Received by: Received by:
Date Date :