Provincial Form
Republic of the Philippines
Department of Health
NATIONAL NUTRITION COUNCIL
Checklist for Functional Barangay Nutrition Committees (BNCs)
As of 2023
Province: Quezon Region: IV-A
Total number of barangays: Total number of functional BNCs:
Instructions: Please fill up column 3 with the names of all barangays. Check each appropriate indicator if present or being done by the LGU. To get the total number of functional BNCs, count the municipalities with check on all
indicators. *Insert another column if necessary.
(NAME OF MUNICIPALITY)
Key Activities Indicators
(Column 3*)
(1) (2) Barangay ®
Program Planning
1. Organization/Re-Organization/ Strengthening of BNC a.. Meetings regularly held at least once every
quarter presided by the mayor or designated
representative
b.. Minutes of meetings documented
2. Conduct of Nutritional Assessment a.. OPT & school weighing report updated
b.. Nutrition situation report prepared
3. Formulation of nutrition action plan a.. NAP integrated into the local development plan
with budget
b.. NAP integrated into the Annual Investment Plan
4. Resource Generation and Mobilization a.. Funds allocated and expended for nutrition and
related activities from annual budget
Service Delivery (e.g. counseling on breastfeeding, organization of b.. Targeted groups provided with nutrition and
peer counsellors, counduct of nutrition education activities, vitamin related interventions
A and iron supplementation to preschool children and pregnant
women; distribution of seedlings to families with underweight
children; supplementary feeding)
Key Activities Indicators
(NAME OF MUNICIPALITY)
(1) (2)
Monitoring and Evaluation a.. Monitoring visits conducted and documented at
least twice a year
b. Quarterly monitoring report prepared and
submitted to Provincial Nutrition Office
c. Program Implementation Review (PIR) conducted
at least once a year with documentation and
submitted to Provincial Nutrition Office
Accomplished by: Date: Reviewed by: _______________________________________ Date: ____________________
Position/Designation: Position/Designation: _________________________
Note: This form should be filled-up by the Provincial Nutrition Action Officer to be submitted to the NNC Regional Office.