BNS Form No.

1A
Philippines Plan of Action for Nutrition
FAMILY PROFILE
Purok / Sitio: PUROK _______ Municipality: IBAAN ___________________
Barangay : COLIAT _______ City / Province: ___________________

HH No. No. of Children Check if: Check if: Fill in: Check if:
No. of <6 6-23 24-59 >60 Couple Toilet Water Food HH HH
HH mos. mos. mos. mos. Educational Practice Type WS, Source Production Using Using
Name of Household Occupation Mother EBF Mixed Bottle Others
Mem Old old old old Attainment Family OP, O, N P,W,S Activity VG, Iodized IFR
Pregnant Feeding Fed
bers planning P/L, FP Salt

Abbreviation
CF – Complimentary IFR – Iron Educational Attainment Toilet Water Source Food Production Activity
EBF_ Exclusive F – Father EU- Elem, Undergraduate CU- College Undergraduate WS- Water Sealed P- Pipe VG- Vegetable Garden
HH – Household M – Mother EG – Elem. Graduate CG – College Graduate OP – Open Pit W- Well P/L – Poultry / Livestock
HU – HS Graduate V- Vocational O- Others S- spring FP - Fishpond
HG – HS Graduate O- Others N- None

BNS Form No. 1A

Philippines Plan of Action for Nutrition
 FAMILY PROFILE
Purok / Sitio: PUROK _______ Municipality: IBAAN ___________________
Barangay : COLIAT _______ City / Province: ___________________

HH No. No. of Children Check if: Check if: Fill in: Check if:
No. of <6 6-23 24-59 >60 Couple Toilet Water Food HH HH
HH mos. mos. mos. mos. Educational Practice Type WS, Source Production Using Using
Name of Household Occupation Mother EBF Mixed Bottle Others
Mem Old old old old Attainment Family OP, O, N P,W,S Activity VG, Iodized IFR
Pregnant Feeding Fed
bers planning P/L, FP Salt
B COMETA, EUGENIO
COMETA JANETH
B12 PATENA MARIO P
M
13 MANALO VICTOR
MANALO ROSA
14 PEREZ ELMER

15 CARINGAL RAMON
CARINGAL ANNALIZA G
16 SORIANO ELMER
SORIANO SHEENALYN
17 VACANT
VACANT
18 PEREZ LORENZO
PEREZ MA. LUZ
19

M
20 PATENA FRANCISCO
PATENA REMEDIOS
BRIONES ERNESTO
21
BRIONES AMOR
ELEJORDE RALF RENAN V
22
ELEJORDE MEANE JOY
DANICO EDWIN E
23
SAMPAGA NOIME L
TORRANO
24
TORRANO MACARIA R
Abbreviation
CF – Complimentary IFR – Iron Educational Attainment Toilet Water Source Food Production Activity
EBF_ Exclusive F – Father EU- Elem, Undergraduate CU- College Undergraduate WS- Water Sealed P- Pipe VG- Vegetable Garden
HH – Household M – Mother EG – Elem. Graduate CG – College Graduate OP – Open Pit W- Well P/L – Poultry / Livestock
HU – HS Graduate V- Vocational O- Others S- spring FP - Fishpond
HG – HS Graduate O- Others N- None

BNS Form No. 1A

Philippines Plan of Action for Nutrition
 FAMILY PROFILE
Purok / Sitio: PUROK _______ Municipality: IBAAN ___________________
Barangay : COLIAT _______ City / Province: ___________________

HH No. No. of Children Check if: Check if: Fill in: Check if:
No. of <6 6-23 24-59 >60 Couple Toilet Water Food HH HH
HH mos. mos. mos. mos. Educational Practice Type WS, Source Production Using Using
Name of Household Occupation Mother EBF Mixed Bottle Others
Mem Old old old old Attainment Family OP, O, N P,W,S Activity VG, Iodized IFR
Pregnant Feeding Fed
bers planning P/L, FP Salt
F
M
F
M
F
M
F
M
F
M
F
M
F
M
F
M
F
M
F
M
F
M
F
M
F
M
F
M
Abbreviation
CF – Complimentary IFR – Iron Educational Attainment Toilet Water Source Food Production Activity
EBF_ Exclusive F – Father EU- Elem, Undergraduate CU- College Undergraduate WS- Water Sealed P- Pipe VG- Vegetable Garden
HH – Household M – Mother EG – Elem. Graduate CG – College Graduate OP – Open Pit W- Well P/L – Poultry / Livestock
HU – HS Graduate V- Vocational O- Others S- spring FP - Fishpond
HG – HS Graduate O- Others N- None

BNS Form No. 1A

Philippines Plan of Action for Nutrition
FAMILY PROFILE
Purok / Sitio: PUROK _______ Municipality: IBAAN ___________________
Barangay : COLIAT _______ City / Province: ___________________

HH No. No. of Children Check if: Check if: Fill in: Check if:
No. of <6 6-23 24-59 >60 Couple Toilet Water Food HH HH
HH mos. mos. mos. mos. Educational Practice Type WS, Source Production Using Using
Name of Household Occupation Mother EBF Mixed Bottle Others
Mem Old old old old Attainment Family OP, O, N P,W,S Activity VG, Iodized IFR
Pregnant Feeding Fed
bers planning P/L, FP Salt
F
M
F
M
F
M
F
M
F
M
F
M
F
M
F
M
F
M
F
M
F
M
F
M
F
M
F
M
Abbreviation
CF – Complimentary IFR – Iron Educational Attainment Toilet Water Source Food Production Activity
EBF_ Exclusive F – Father EU- Elem, Undergraduate CU- College Undergraduate WS- Water Sealed P- Pipe VG- Vegetable Garden
HH – Household M – Mother EG – Elem. Graduate CG – College Graduate OP – Open Pit W- Well P/L – Poultry / Livestock
HU – HS Graduate V- Vocational O- Others S- spring FP - Fishpond
HG – HS Graduate O- Others N- None

BNS Form No. 1A

Philippines Plan of Action for Nutrition
FAMILY PROFILE
Purok / Sitio: PUROK _______ Municipality: IBAAN ___________________
Barangay : COLIAT _______ City / Province: ___________________

No. of Children Check if: Check if: Fill in: Check if:
 HH No. <6 6-23 24-59 >60 Couple Toilet Water Food HH HH
No. of mos. mos. mos. mos. Mother Practice EBF Mixed Bottle Others Type WS, Source Production Using Using
HH Old old old old Educational Family Feeding Fed OP, O, N P,W,S Activity VG, Iodized IFR
Name of Household Occupation Pregnant
Mem Attainment planning P/L, FP Salt
bers
F
M
F
M
F
M
F
M
F
M
F
M
F
M
F
M
F
M
F
M
F
M
F
M
F
M
F
M
Abbreviation
CF – Complimentary IFR – Iron Educational Attainment Toilet Water Source Food Production Activity
EBF_ Exclusive F – Father EU- Elem, Undergraduate CU- College Undergraduate WS- Water Sealed P- Pipe VG- Vegetable Garden
HH – Household M – Mother EG – Elem. Graduate CG – College Graduate OP – Open Pit W- Well P/L – Poultry / Livestock
HU – HS Graduate V- Vocational O- Others S- spring FP - Fishpond
HG – HS Graduate O- Others N- None

BNS Form No. 1A

Philippines Plan of Action for Nutrition
FAMILY PROFILE
Purok / Sitio: PUROK _______ Municipality: IBAAN ___________________
Barangay : COLIAT _______ City / Province: ___________________

HH No. No. of Children Check if: Check if: Fill in: Check if:
 No. of <6 6-23 24-59 >60 Couple EBF Mixed Bottle Others Toilet Water Food HH HH
HH mos. mos. mos. mos. Educational Practice Feeding Fed Type WS, Source Production Using Using
Name of Household Occupation Mother
Mem Old old old old Attainment Family OP, O, N P,W,S Activity VG, Iodized IFR
Pregnant
bers planning P/L, FP Salt
F
M
F
M
F
M
F
M
F
M
F
M
F
M
F
M
F
M
F
M
F
M
F
M
F
M
F
M
Abbreviation
CF – Complimentary IFR – Iron Educational Attainment Toilet Water Source Food Production Activity
EBF_ Exclusive F – Father EU- Elem, Undergraduate CU- College Undergraduate WS- Water Sealed P- Pipe VG- Vegetable Garden
HH – Household M – Mother EG – Elem. Graduate CG – College Graduate OP – Open Pit W- Well P/L – Poultry / Livestock
HU – HS Graduate V- Vocational O- Others S- spring FP - Fishpond
HG – HS Graduate O- Others N- None

BNS Form No. 1A

Philippines Plan of Action for Nutrition
FAMILY PROFILE
Purok / Sitio: PUROK _______ Municipality: IBAAN ___________________
Barangay : COLIAT _______ City / Province: ___________________

HH No. No. of Children Check if: Check if: Fill in: Check if:
 No. of <6 6-23 24-59 >60 Couple EBF Mixed Bottle Others Toilet Water Food HH HH
HH mos. mos. mos. mos. Educational Practice Feeding Fed Type WS, Source Production Using Using
Name of Household Occupation Mother
Mem Old old old old Attainment Family OP, O, N P,W,S Activity VG, Iodized IFR
Pregnant
bers planning P/L, FP Salt
F
M
F
M
F
M
F
M
F
M
F
M
F
M
F
M
F
M
F
M
F
M
F
M
F
M
F
M
Abbreviation
CF – Complimentary IFR – Iron Educational Attainment Toilet Water Source Food Production Activity
EBF_ Exclusive F – Father EU- Elem, Undergraduate CU- College Undergraduate WS- Water Sealed P- Pipe VG- Vegetable Garden
HH – Household M – Mother EG – Elem. Graduate CG – College Graduate OP – Open Pit W- Well P/L – Poultry / Livestock
HU – HS Graduate V- Vocational O- Others S- spring FP - Fishpond
HG – HS Graduate O- Others N- None

BNS Form No. 1A

Philippines Plan of Action for Nutrition
FAMILY PROFILE
Purok / Sitio: PUROK _______ Municipality: IBAAN ___________________
Barangay : COLIAT _______ City / Province: ___________________

HH No. No. of Children Check if: Check if: Fill in: Check if:
 No. of <6 6-23 24-59 >60 Couple EBF Mixed Bottle Others Toilet Water Food HH HH
HH mos. mos. mos. mos. Educational Practice Feeding Fed Type WS, Source Production Using Using
Name of Household Occupation Mother
Mem Old old old old Attainment Family OP, O, N P,W,S Activity VG, Iodized IFR
Pregnant
bers planning P/L, FP Salt
F
M
F
M
F
M
F
M
F
M
F
M
F
M
F
M
F
M
F
M
F
M
F
M
F
M
F
M
Abbreviation
CF – Complimentary IFR – Iron Educational Attainment Toilet Water Source Food Production Activity
EBF_ Exclusive F – Father EU- Elem, Undergraduate CU- College Undergraduate WS- Water Sealed P- Pipe VG- Vegetable Garden
HH – Household M – Mother EG – Elem. Graduate CG – College Graduate OP – Open Pit W- Well P/L – Poultry / Livestock
HU – HS Graduate V- Vocational O- Others S- spring FP - Fishpond
HG – HS Graduate O- Others N- None

BNS Form No. 1A

Philippines Plan of Action for Nutrition
FAMILY PROFILE
Purok / Sitio: PUROK _______ Municipality: IBAAN ___________________
Barangay : COLIAT _______ City / Province: ___________________

HH No. No. of Children Check if: Check if: Fill in: Check if:
 No. of <6 6-23 24-59 >60 Couple EBF Mixed Bottle Others Toilet Water Food HH HH
HH mos. mos. mos. mos. Educational Practice Feeding Fed Type WS, Source Production Using Using
Name of Household Occupation Mother
Mem Old old old old Attainment Family OP, O, N P,W,S Activity VG, Iodized IFR
Pregnant
bers planning P/L, FP Salt
F
M
F
M
F
M
F
M
F
M
F
M
F
M
F
M
F
M
F
M
F
M
F
M
F
M
F
M
Abbreviation
CF – Complimentary IFR – Iron Educational Attainment Toilet Water Source Food Production Activity
EBF_ Exclusive F – Father EU- Elem, Undergraduate CU- College Undergraduate WS- Water Sealed P- Pipe VG- Vegetable Garden
HH – Household M – Mother EG – Elem. Graduate CG – College Graduate OP – Open Pit W- Well P/L – Poultry / Livestock
HU – HS Graduate V- Vocational O- Others S- spring FP - Fishpond
HG – HS Graduate O- Others N- None

BNS Form No. 1A

Philippines Plan of Action for Nutrition
FAMILY PROFILE
Purok / Sitio: PUROK _______ Municipality: IBAAN ___________________
Barangay : COLIAT _______ City / Province: ___________________

HH No. No. of Children Check if: Check if: Fill in: Check if:
No. of <6 6-23 24-59 >60 Couple Toilet Water Food HH HH
HH mos. mos. mos. mos. Educational Practice Type WS, Source Production Using Using
Name of Household Occupation Mother EBF Mixed Bottle Others
Mem Old old old old Attainment Family OP, O, N P,W,S Activity VG, Iodized IFR
Pregnant Feeding Fed
bers planning P/L, FP Salt
 F
M
F
M
F
M
F
M
F
M
F
M
F
M
F
M
F
M
F
M
F
M
F
M
F
M
F
M
Abbreviation
CF – Complimentary IFR – Iron Educational Attainment Toilet Water Source Food Production Activity
EBF_ Exclusive F – Father EU- Elem, Undergraduate CU- College Undergraduate WS- Water Sealed P- Pipe VG- Vegetable Garden
HH – Household M – Mother EG – Elem. Graduate CG – College Graduate OP – Open Pit W- Well P/L – Poultry / Livestock
HU – HS Graduate V- Vocational O- Others S- spring FP - Fishpond
HG – HS Graduate O- Others N- None