DEPARTMENT OF SOCIAL WELFARE AND DEVELOPMENT

SUPPLEMENTARY FEEDING PROGRAM

WEIGHT MONITORING FORM

WEIGHT-FOR-HEIGHT
Name of CDC:
Name of CDW:
Location:

NUTRIONAL STATUS
No. Name of Children SEX UPON ENTRY/INITIAL After _____ days _______to After ____ days _______to
Date of Age Height Weight Nutrition Date of Age Height Weight Nutrition Date of Age Height Weight Nutrition
Weighting (in mo.) (in cm) (in kls) Status Weighting (in mo) (in cm) (in kls) Status Weighting (in mo) (in cm) (in kls) status
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
Legend: Prepared by: Certified by:
SW – Severely Wasted
W – Wasted - CDW ____________________
N – Normal Name/Position Name/Position
OW – Overweight Records
WRNA – Weight Records Not Available
DROOPED – Transferred Risedence Date
DEPARTMENT OF SOCIAL WELFARE AND DEVELOPMENT
SUPPLEMENTARY FEEDING PROGRAM

WEIGHT MONITORING FORM

WEIGHT-FOR-HEIGHT
Name of CDC:
Name of CDW:
Location:

NUTRIONAL STATUS
No. Name of Children SEX UPON ENTRY/INITIAL After _____ days _______to After ____ days _______to
Date of Age Height Weight Nutrition Date of Age Height Weight Nutrition Date of Age Height Weight Nutrition
Weighting (in mo.) (in cm) (in kls) Status Weighting (in mo) (in cm) (in kls) Status Weighting (in mo) (in cm) (in kls) status
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
Legend: Prepared by: Certified by:
SW – Severely Wasted
W – Wasted - CDW ____________________
N – Normal Name/Position Name/Position
OW – Overweight Records
WRNA – Weight Records Not Available
DROOPED – Transferred Risedence Date
Department of Social Welfare and Development
Field Office IV-A
Supplementary Feeding Program
Summary of Nutritonal Status (Using Weight-for-Height Indicator)

City/Municipality: ________________________
Province: _______________________________
School Year: ____________________________

UPON ENTRY
Date Date
Day Care Center No. of No. of No. of Feeding Feedings
DCCh Male Female Started Ends SW W N OW Total
dd/mm/yyyy dd/mm/yyyy
Male Femal Total Mal Female Tota Male Femal Total Mal Female Tota Male Femal Total
e e l e e l e
CHILD
DEVELOPMENT
CENTER

Legend: Prepared by:

SW – Severely Wasted
W – Wasted
N – Normal CDW
OW – Overweight Records
WRNA – Weight Records Not Available
DROOPED – Transferred Risedence