DEPARTMENT OF SOCIAL WELFARE AND DEVELOPMENT

Milk Feeding Program

Masterlist of Beneficiaries SY: 2023-2024
Name of Day Care Center/ SNP: ____________________________________________________
Name of Child Development Worker: _________________________________________
Location (Brgy. & Province):_________________________________________________
Session (AM/PM) & Time of Feeding: _________________________________________________________
NUTRITIONAL STATUS
Pantawid
DATE OF ACTUAL DATE HT.
Member (pls
NAME OF PARENT/ NAME OF CHILD (Full AGE IN specify RCCT / PWD (pls put a
Child of Solo
NO. Address (Brgy.) GUARDIAN Name) SEX BIRTH OF WEIGHING WT. (kg) (cm) MONTHS Weight-for-
Weight-for- Height-for- Summary of 4p's or MCCT and check mark)
Parent (pls put a
Height Age Undernourish check mark)
(y/m/d) (y/m/d) Age
(Wasting) (Stunting) ed Children
indicate reference
number)

1 NORMAL WASTED STUNTED 1

2
3
4
5
6
7
8
9
10
11
12
13
14
15
TOTAL:
Nutritional Status: (using WHO-CGS as reference)
N- Normal Prepared by: Noted by:
UW-Underweight
SUW- Severely Underweight _____________________________ ____________________________________
OW- Overweight Child Development Worker City/ Mun. Social Welfare & Dev't Officer
O- Obese
MW-Moderately Wasted
SW- Severely Wasted
St- Stunted
SSt- Severely Stunted
T- Tall
 DEPARTMENT OF SOCIAL WELFARE AND DEVELOPMENT
Supplementary Feeding Program
Masterlist of Beneficiaries SY: 2023-2024
Name of Day Care Center/ SNP: ____________________________________________________
Name of Child Development Worker: _________________________________________
Location (Brgy. & Province):_________________________________________________
Session (AM/PM) & Time of Feeding: _________________________________________________________
NUTRITIONAL STATUS
Pantawid
DATE OF ACTUAL DATE HT.
Member (pls
NAME OF PARENT/ NAME OF CHILD (Full AGE IN specify RCCT / PWD (pls put a
Child of Solo
NO. Address (Brgy.) GUARDIAN Name) SEX BIRTH OF WEIGHING WT. (kg) (cm) MONTHS Weight-for-
Weight-for- Height-for- Summary of 4p's or MCCT and check mark)
Parent (pls put a
Height Age Undernourish check mark)
(y/m/d) (y/m/d) Age
(Wasting) (Stunting) ed Children
indicate reference
number)

1 NORMAL WASTED STUNTED 1

2
3
4
5
6
7
8
9
10
11
12
13
14
15
TOTAL:
Nutritional Status: (using WHO-CGS as reference)
N- Normal Prepared by: Noted by:
UW-Underweight
SUW- Severely Underweight _____________________________ ____________________________________
OW- Overweight Child Development Worker City/ Mun. Social Welfare & Dev't Officer
O- Obese
MW-Moderately Wasted
SW- Severely Wasted
St- Stunted
SSt- Severely Stunted
T- Tall