SBFP Form 1 (2021)

Department of Education
Region ___

Master List Beneficiaries for School-Based Feeding Program (SBFP) (SY________)

Division/Province: ______________________________________ Name of Principal : ____________________________________

City/ Municipality/Barangay : ____________________________ Name of Feeding Focal Person : _________________________
Name of School / School District : _________________________
School ID Number: _________________________

Nutritional Parent's
BMI for
Grade/ Date of Weighing / Age in Weight Height 6 y.o. Status (NS) Dewormed? consent for
Date of Birth
No. Name Sex Measuring Years / milk?
Section (MM/DD/YYYY)
(MM/DD/YYYY) Months (Kg) (cm) and
(yes or no) (yes or
above
no)
BMI-A HFA
1 Ahit, Mark C. M K- yellow06/17/2017 09/18/2022 5-3 13 110 SW YES YES
2
3
4
5
6
7
8
9
10
11
12
13
Prepared by: Approved by:
 (COUNTER SIGN Nurse)
__________________________________ School Head
Feeding Focal Person

Note: This form shall be prepared by the school before the start of feeding to be compiled by the SDO.
Keep columns 6-12 blank if nutritional assesment is still suspended.
 Beneficiary of
Participation
SBFP in
in 4Ps
Previous Years
(yes or no)
(yes or no)

NO NO
SBFP Form 2 (2021)
Department of Education
Region CARAGA

SCHOOL-BASED FEEDING PROGRAM (SBFP) SUMMARY OF BENEFICIARIES & START OF FEEDING (SY 2021-2022)
Division/Province: AGUSAN DEL SUR
City/ Municipality/Barangay : TALACOGON/ CAUSWAGAN
Name of School / School District : SAN ISIDRO ES/ TALACOGON EAST DISTRICT
School ID Number: 212059
Date of Start of Feeding: __________________________
Last Mile School: ___Y / N
Nutritional Status at Start/End of Feeding No. of Secondary Targets

Number of Undernourished School SW W N OW+O SS S N T No. of Pupils- No. of No. of No. of

at-risk-of- Stunted/ Indigent Indigenous
Children by Grade Level dropping-out Severely Learners Peoples (IPs)
(PARDOs) Stunted

1. Kinder 0 0 9

2. Grade I 6 5

3. Grade II 3 2

4. Grade III 0 2

5. Grade IV 0 7

6. Grade V 0 1

7. Grade VI 0 0

Total 9 17 9 0 0 0 0 0 0 0 0 0

Prepared by: Approved by:

(COUNTER SIGN Nurse)

MARIFE JOY ESCOZA THELMA P. CRUZ
 SBFP DepEd Focal School Head

Note: This form shall be prepared by the school before the start of feeding and after feeding, to be compiled by the SDO, and for final compilation by the RO
EEDING (SY 2021-2022)

No. of 4 No. of 4 Ps No. of Pupils Date Feeding

Learners Beneficiaries who are Started/Ended
Dewormed beneficiaries
in previous
years
(Repeaters)

9 9 0

11 9 11

5 5 5

2 2 2

7 7 7

1 1 1

0 0 0

35 33 26

LMA P. CRUZ
chool Head

al compilation by the RO, for submission to DepEd BLSS-SHD

 SBFP Form 3 (2021)
SCHOOL-BASED FEEDING PROGRAM
RECORD OF DAILY FEEDING

FOR THE MONTH OF OCTOBER, SY 2023-2024

Region CARAGA
Division AGUSAN DEL SUR School: _____________________________________
District TALACOGON EAST School ID Number: _________________________

NAME OF PUPIL ACTUAL FEEDING

25 26 27 28 29

1 2 3 4 6 7 8 9 9 10 11 12 13 14 15
1 AHIT. MARK C. N2/M N/M N/M N/M
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
TOTAL:
 Prepared by:

____________________________
B. Deworming D. Actual Feeding
Feeding Teacher / School Nurse
( x ) - not dewormed (N ) - Present, served with NFP
Approved by: ( √ ) - dewormed (M ) - Present, served with Milk
(N/M ) - Present, served with NFP & Milk
( A ) - Absent, not served
School Head (N2/M2/(N/M2)) - Present, served twice

Note: This form shall be prepared by the school to be consolidated using the Revised OKD Form A.
16 17 18 19 20
 SBFP Form 3 (2021)

SCHOOL-BASED FEEDING PROGRAM

FOR THE MONTH OF ______________________ , SY _____________

Region ____________________________
Division ___________________________ School: _____________________________________
District ___________________________ Grade: __________ Section _____________________
School ID Number: _________________________

ACTUAL FEEDING

NAME OF PUPIL

21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
TOTAL:

page 2
 D. Actual Feeding

(N ) - Present, served with NFP

(M ) - Present, served with Milk
(N/M ) - Present, served with NFP & Milk
( A ) - Absent, not served
(N2/M2/(N/M2)) - Present, served twice

page 2
53 54 55 56 57 58 59 60

page 2
 SBFP Form 3 (2021)

SCHOOL-BASED FEEDING PROGRAM

FOR THE MONTH OF ______________________ , SY _____________

Region ____________________________
Division ___________________________ School: _____________________________________
District ___________________________ Grade: __________ Section _____________________
School ID Number: _________________________

ACTUAL FEEDING

NAME OF PUPIL

61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
TOTAL:

page 3
 D. Actual Feeding

(N ) - Present, served with NFP

(M ) - Present, served with Milk
(N/M ) - Present, served with NFP & Milk
( A ) - Absent, not served
(N2/M2/(N/M2)) - Present, served twice

page 3
93 94 95 96 97 98 99 100

page 3
 SBFP Form 3 (2021)

SCHOOL-BASED FEEDING PROGRAM

FOR THE MONTH OF ______________________ , SY _____________

Region ____________________________
Division ___________________________ School: _____________________________________
District ___________________________ School ID Number: _________________________

ACTUAL FEEDING
ATTENDANCE
NAME OF PUPIL No. of
Days
Present
101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 (A)
1 30/33
2 30/16
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
TOTAL: AVERAGE:

page 4
 D. Actual Feeding

(N ) - Present, served with NFP

(M ) - Present, served with Milk
(N/M ) - Present, served with NFP & Milk
( A ) - Absent, not served
(N2/M2/(N/M2)) - Present, served twice

page 4
ATTENDANCE
No. of
Feeding Percentage
Days
(B) (A/B)*100
30/33 100/100 COMMERCIAL MILK
30/16 100/100 FRESH MILK

AVERAGE:

page 4
SBFP Form 5 (2020)

DEPARTMENT OF EDUCATION
Region CARAGA

REGION/DIVISION/DISTRICT: CARAGA/AGUSAN DEL SUR/ TALACOGON EAST

NAME OF SCHOOL: SAN ISIDRO ES
SCHOOL ID NO.: 212059

SCHOOL-BASED FEEDING PROGRAM - NFP/MILK

LIST OF AUTHORIZED CONSIGNEES (SY 2022-2023)

NAME & DESIGNATION TEL. NO. MOBILE NO. EMAIL ADD SPECIMEN
SIGNATURE
1 (School Head) THELMA CRUZ
NONE 09078672245
[email protected]
2 (School Feeding Coordinator) MARIF
NONE 09634456723
[email protected]
3 (School Property Custodian) RICHARD
NONE 09176523456
[email protected]

SCHOOL INSPECTION TEAM (SY 2022-2023)

NAME & DESIGNATION TEL. NO. MOBILE NO. EMAIL ADD SPECIMEN
SIGNATURE
1 THELMA CRUZ
NONE 09078672245 THELMA.CRUZ@
DEPED.GOV.PH
2 PRECY SUMIPO
NONE 09085672345
[email protected]
3 CHARLOTTE SINGSON
NONE 09083456789
[email protected]
SBFP Form 5 (2020)

Note: Only authorized consignees are allowed to receive the goods.

SBFP Form 5 (2021)

DEPARTMENT OF EDUCATION
Region CARAGA

REGION/DIVISION/DISTRICT: CARAGA/AGUSAN DEL SUR/ TALACOGON EAST

NAME OF SCHOOL: SAN ISIDRO ES
SCHOOL ID NO.: 212059

SCHOOL-BASED FEEDING PROGRAM - MILK COMPONENT

LIST OF BENEFICIARIES (SY 2022-2023)

Classification of Students in terms of Milk Tolerance
(Please check one)
Without milk With milk Not allowed by
intolerance and will intolerance but parents to
Name Grade & Section participate in milk willing to participate in milk
feeding participate in milk feeding
feeding
1 IVAN CAMARINES Kinder - A /
2 DEGUINIO DANIEL Kinder - A /
3 ENGALAN LEO JAY Kinder - A /
4 MERCADO ANGELOU Kinder - A /
5 MERCADO LEO Kinder - A /
6 PEREZ JOHN CRIS Kinder - A /
7 RAMOS JAKE Kinder - A /
8 BORMUEL KYLIE MAE Kinder - A /
9 MERCADO NELIAN Kinder - A /
10 ENGALAN JEFRIL Grade 1 - Okra /
11 GONZALES CHRIST JOY Grade 1 - Okra /
12 GONZALES JERWIN Grade 1 - Okra /
13 GOYO FLORO Grade 1 - Okra /
14 MANLANGIT VENCENT Grade 1 - Okra /
15 MARIANITO VERNAN Grade 1 - Okra /
16 MARIENTES JOHN KYLLE Grade 1 - Okra /
17 ONEZ NINO Grade 1 - Okra /
18 OTAZA CHARLIE Grade 1 - Okra /
19 LACIA PRENCES CARLYN Grade 1 - Okra /
20 RIZAGA CHARLYN Grade 1 - Okra /
21 DAAS NELK CHRIST Grade 2 - Hope /
SBFP Form 5 (2021)

22 GOLORAN RICK JOHN Grade 2 - Hope /

23 LACIBAL MELBE Grade 2 - Hope /
24 RAMOS JESSEL MAY Grade 2 - Hope /
25 BARRIOS MARLON Grade 2 - Hope /
26 GOYO JOHN MIKE Grade 3 - Apple /
27 MERCADO RIAN Grade 3 - Apple /
28 MANLANGIT ELDRIAN Grade 4 - Gold /
29 MARIANITO SHELDON Grade 4 - Gold /
30 GOYO ANGELINE Grade 4 - Gold /
31 OTAZA CERELYN Grade 4 - Gold /
32 RAMOS JEIAN Grade 4 - Gold /
33 MERCADO JOYFUL Grade 4 - Gold /
34 MERCADO NEIL JUNE Grade 4 - Gold /
35 ONEZ DICKENS Grade 5 - Narra /
Prepared by: APPROVED BY:

MARIFE JOY ESCOZA THELMA P. CRUZ

School Feeding Coordinator School Head
SBFP Form 6 (2021)

DEPARTMENT OF EDUCATION
Region CARAGA

REGION/DIVISION/DISTRICT: CARAGA/AGUSAN DEL SUR/ TALACOGON EAST

NAME OF SCHOOL: SAN ISIDRO ES
SCHOOL ID NO.: 212059

SCHOOL-BASED FEEDING PROGRAM

NFP DELIVERIES (SY2022-2023)

Grade Level Number of Beneficiaries Date Delivered No. of Packs Received No. of Packs for
Replacement/
New Replacement Total (New + Rejected
Replacement)
Kinder 9 AUG. 28, 2022 34 1 35 0
Grade 1 11 Sep 10, 2022 35 0 35
Grade 2 5 Sept 20, 2022 35 0 35
Grade 3 2
Grade 4 7
Grade 5 1
Grade 6 0
TOTAL: 35

MILK DELIVERIES (SY 2022-2023)

Grade Level Number of Beneficiaries Date Delivered No. of Packs Received No. of Packs for
Replacement/
New Replacement Total (New + Rejected
Replacement)
Kinder 9 SEP. 5, 2022 34 1 35 1
Grade 1 11 Sep 10, 2022
Grade 2 5
Grade 3 2
Grade 4 7
Grade 5 1
Grade 6 0
TOTAL: 35
SBFP Form 6 (2021)

Prepared by: APPROVED BY:

MARIFE JOY ESCOZA THELMA P. CRUZ

School Feeding Coordinator School Head
SBFP Form 6 (2021)

Remarks

1 PC MILKY BUN LACKING

Remarks

foul smell