SBFP Form 4

SCHOOL-BASED FEEDING PROGRAM

FOR THE MONTH OF

, SY

Region

VIII

School

Pupua Elementary School

Division

Catbalogan City

Grade

One

District

Catbalogan IV

2016-2017

Section

OCTOBER

NOVEMBER

ACTUAL
FEEDING

NAME OF PUPIL

6
1

6
2

6
3

6
4

6
5

6
6

/
/
/

/
/
/

/
/
/

/
/
/

/
/
/

/
/
/

6
7

6
7

6
8

6
9

7
0

7
1

7
2

7
3

7
4

7
5

7
6

7
7

7
8

7
9

8
0

8
1

8
2

8
3

8
4

8
5

8
6

8
7

88

8
8

9
0

9
1

9
2

9
3

9
4

9
5

9
6

9
7

9
8

9
9

10
0

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/
/

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/

1. Duena, Edmark G.
2. Gawas, Alvin D.
3. Blarmino, Jonalyn M.

D. Actual Feeding
(/) Present, served
(A) Absent, not served
(//) Present, served twice

SBFP Form 4
SCHOOL-BASED FEEDING PROGRAM
FOR THE MONTH OF

, SY

Region

VIII

School

Pupua Elementary School

Division

Catbalogan City

Grade

One

District

Catbalogan IV

2016-2017

Section

AUGUST
0

2
1

2
2

2
3

2
4

2
5

/
/
/

/
/
/

/
/
/

/
/
/

/
/
/

NAME OF PUPIL

1. Duena, Edmark G.
2. Gawas, Alvin D.
3. Blarmino, Jonalyn M.

ACTUAL FEEDING

2
6

2
7

2
8

2
9

3
0

3
1

3
2

3
3

3
4

3
5

3
6

3
7

3
8

3
9

4
0

4
1

4
2

4
3

4
4

4
5

4
6

4
7

4
8

49

5
0

5
1

5
2

5
3

5
4

5
5

5
6

5
7

5
8

5
9

/
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/
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/
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/
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/
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/
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/

D. Actual Feeding
(/) Present, served
(A) Absent, not served
(//) Present, served twice

/
/
/

/
/
/

SBFP Form 4
SCHOOL-BASED FEEDING PROGRAM
FOR THE MONTH OF

, SY

Region

VIII

School

Pupua Elementary School

Division

Catbalogan City

Grade

One

District

Catbalogan IV

2016-2017

Section

ACTUAL FEEDING
NAME OF PUPIL

4Ps
beneficiary
(y or n)

Beneficiar
y of
Previous
SBFP (y or
n)

Age

Birth
Date

sex

DEWORMIN
G

1. Duena, Edmark G.

M Yes

IN

5:00

7-29-10

2. Gawas, Alvin D.

M No

IN

6:00

2-27-10

3. Blarmino, Jonalyn M.

F Yes

IN

6:04

3-8-10

Prepared by:

Nutritional Status

Ht
Cm

Wt
Kg

Dat
e
Take
n

N
S

(/)
OR
(X)

1.1
1
1.0
7
1.1
4

12

7-116

S
W

13

7-116

15

7-116

Dat
e
Take
n

0
8

1
0

1
1

1
2

1
3

1
4

1
5

1
6

1
7

1
8

1
9

20

S
W

S
W

LEGEND
A. Nutritional Status
For 6-19 y.o
For Below 6 y.o
B. Deworming
SUSeverely
SW- Severely
(x) not dewormed
Underweight
Wasted
(/) - dewormed
TOTAL: U- Underweight
W- Wasted
N- Normal
N- Normal
Ow- Overweight
Ow- Overweight
O- Obese

D. Actual Feeding
(/) Present, Serve
(A) Absent, not Served
(//)- Present, Serve Twice

Feeding Teacher/ School Nurse