BNS Form No.

1A
Philippine Plan of Action for Nutrition
FAMILY PROFILE
Purok/Sitio:__________________________________ Municipality:
Barangay: ___________________________________ City/Province:
HH No. of No. of Children Name of Household Head/ Spouse Occupation Educa- Check If: Check If: Fill in: Check if:
No. HH <6 6-23 24-59 >60 tional Mother Couple Nursing 6 mos. child Toilet Water Food HH using HH
Mem- mos. mos. mos. mos. attain- preg- Practice EBF Mixed Bottle- Others type (WS, Source Production iodized using
bers old old old old ment nant Family feeding fed OP, O, N) (P, W, S) Activity (VG, salt IFR
Planning P/L, FP)
(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)
(F)
(M)
Abbreviations
CF - Complementary IFR - Iron Fortified Rice Educational attainment Toilet Water source Food Production Activity
EBF - Exclusive (F) - Father EU - Elem. Undergraduate CU - College WS - Water sealed P - Pipe VG - Vegetable garden
HH - Household (M) - Mother EG - Elem. Graduate CG - College OP - Open pit W - Well P/L - Poultry/ Livestock
HU - HS Undergraduate V - Vocational O - Others S - Spring FP - Fishpond
HG - HS Graduate O - Others N - None