DEPARTMENT OF SOCIAL WELFARE AND DEVELOPMENT
Milk FEEDING PROGRAM
ASSESSMENT ON THE NUTRITIONAL STATUS OF SFP BENEFICIARIES
City/Municipality _____________________________________
Province _____________________________________ TOTAL NUMBER OF FEEDING DAYS: _________________________________
NUTRITIONAL STATUS
UPON ENTRY/BASELINE NUTRITIONAL STATUS LATEST/CURRENT NUTRTITIONAL STATUS
DAY CARE CENTER/ NO. OF
BARANGAY BENEFICIARIES Overweight Normal Underweight Severely Underweight Wasted Severely Wasted Stunted Severely Stunted No. of Overweight Normal Underweight Severely Underweight Wasted Severely Wasted Stunted Severely Stunted No. of
Date of Date of
Weighing Undernouri Weighing Undernour
M F M F M F M F M F M F M F M F shed M F M F M F M F M F M F M F M F ished
1 2021/12/01
2
3
4
5
6
7
8
9
10
11
12
13
14
15
TOTAL 0 0
Nutritional Status: (Using CGS as reference) PREPARED BY:
SUW - Severely Underweight
UW - Underweight
N - Normal _______________________________________
OW - Overweight
W- Wasted
SW- Severely Wasted
S- Stunted
SS- Severely Stunted
SFP Form 3.a
Submit at the end of 120 feeding days
DEPARTMENT OF SOCIAL WELFARE AND DEVELOPMENT
Supplementary Feeding Program
WEIGHT MONITORING FORM
Name of DCC __________________________________
Name of DCW __________________________________
Location __________________________________
NUTRITIONAL STATUS
UPON ENTRY 30 DAYS AFTER 60 DAYS AFTER
Date of NUTRITIONAL STATUS NUTRITIONAL STATUS NUTRITIONAL STATUS
NAME OF CHILDREN SEX REMARKS
Birth AGE HEIGHT WEIGHT DEWORMING VIT A
No. of
AGE HEIGHT WEIGHT
No. of
AGE
HEIGHT
WEIGHT
No. of
DATE OF WEIGHING Undernourished DATE OF WEIGHING Undernourished DATE OF WEIGHING (in Undernourished
(in mos) (in cm) (in kilos) (1st dose) SUPPLEMENTATION (in mos) (in cm) (in kilos) Weight for (in mos) (in kilos) Weight for
Weight for Height Height for Age children Weight for Height for Age children cm) Weight for Height for Age children
Weight for Age Height Height
(Wasting) (Stunting) Age (Stunting) Age (Stunting)
(Wasting) (Wasting)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
This form shall be used every month in recording weight and height of the child to determine the improvement in child's nutritional status
*DCW should indicate date or month and year when the child was dewormed and provided Vit.A
Legend:
Weight for Age: Height for Age Weight for Height Prepared by:
N - Normal N - Normal N - Normal
UW - Underweight S - Stunted W- Wasted _______________________________________ __________________________
SUW - Severely Underweight SS- Severely Stunted SW - Severely Wasted Name/Position Date
OW- Overweight T- Tall OW- Overweight
O-Obese O-Obese
SFP Form 3.a
Submit at the end of 120 feeding days
DEPARTMENT OF SOCIAL WELFARE AND DEVELOPMENT
Supplementary Feeding Program
WEIGHT MONITORING FORM
Name of DCC __________________________________
Name of DCW __________________________________
Location __________________________________
NUTRITIONAL STATUS
UPON ENTRY 90 DAYS AFTER 120 DAYS AFTER
Date of NUTRITIONAL STATUS NUTRITIONAL STATUS NUTRITIONAL STATUS
NAME OF CHILDREN SEX REMARKS
Birth AGE HEIGHT WEIGHT DEWORMING VIT A
No. of
AGE HEIGHT WEIGHT
No. of
AGE
HEIGHT
WEIGHT
No. of
DATE OF WEIGHING SUPPLEMENTATION Undernourished DATE OF WEIGHING Weight for Undernourished DATE OF WEIGHING (in Weight for Undernourished
(in mos) (in cm) (in kilos) (1st dose) Weight for Height Height for Age (in mos) (in cm) (in kilos) Weight for Height for Age (in mos) (in kilos) Weight for Height for Age
Weight for Age children Height children cm) Height children
(Wasting) (Stunting) Age (Stunting) Age (Stunting)
(Wasting) (Wasting)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
This form shall be used every month in recording weight and height of the child to determine the improvement in child's nutritional status
*DCW should indicate date or month and year when the child was dewormed and provided Vit.A
Legend:
Weight for Age: Height for Age Weight for Height Prepared by:
N - Normal N - Normal N - Normal
UW - Underweight S - Stunted W- Wasted _______________________________________ __________________________
SUW - Severely Underweight SS- Severely Stunted SW - Severely Wasted Name/Position Date
OW- Overweight T- Tall OW- Overweight
O-Obese O-Obese
