REPUBLIKA NG PILIPINAS

PROBINSYA NG BATANGAS
BAYAN NG IBAAN
BARANGAY COLIAT
OPT Plus Form 1. List of preschoolers with weight and height measurement and Identified Nutrition Status
Philippine Plan of Action for Nutrition

Barangay: COLIAT City/Municipality: IBAAN Province: BATANGAS Year:_______________ Date of OPT Plus:___________

Puro Date of (Yr – Mo - Day) Nutritional Status

Length/
k Household Name of Household Measurement Age in Weight Length/ Weight
Name of Preschooler Height Weight
Number Head/Mother/Caregiver Sex Birthday Length/ months (kg) Height for
Weight (cm) for age
Height for age Length
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14)

*Codes for Nutritional Status: Weight for age: N- Normal UW- Underweight SUW- Severely Underweight OW- Overweight
Note: Use WEIGHT-FOR-LENGTH for 0-23 months old preschool and
Length/Height-for-age: N- Normal ST- Stunning SST- Severely Stunning T- Tall
Weight for Length/Height: N- Normal W- Wasted SW- Severely Wasted OW- Overweight WEIGHT-FOR-HEIGHT for 24-60 months old preschool children
OB- Obese Use WEIGHT-FOR-LENGTH or WEIGHT-FOR-HEIGHT to
1/’ Age in months” refers to a complete number of months. For instance, 34 months and 27 days is considered 34 months only. correctly determine overweight and obesity.

Prepared by: Checked: _____________________________

Name and Signature of Barangay Nutrition Scholar Name and Signature of Midwife/Nurse/District/City Nutritionist
Program Coordinator

Date: _____________________________ Date________________________________