SFP Form 3.
a
Submit at the end of 120 feeding days
DEPARTMENT OF SOCIAL WELFARE AND DEVELOPMENT
Milk Feeding Program
WEIGHT MONITORING FORM
Name of DCC __________________________________
Name of DCW __________________________________
Location __________________________________
NUTRITIONAL STATUS
UPON ENTRY 30 DAYS AFTER 60 DAYS AFTER
Date
NAME OF NUTRITIONAL STATUS NUTRITIONAL STATUS NUTRITIONAL STATUS
of SEX REMARKS
CHILDREN DATE OF AGE DEWORMI VIT A No. of AGE Weight No. of AGE HEIGHT WEIGHT Weight No. of
Birth WEIGHIN (in
HEIGHT WEIGHT
NG (1st SUPPLEMEN Weight for Undernourish
DATE OF
(in
HEIGHT WEIGHT
for Undernourish
DATE OF
(in (in for Undernourish
(in cm) (in kilos) Weight for Height for Age ed children WEIGHING mos) (in cm) (in kilos) Weight Height for Age ed children WEIGHING Weight Height for Age ed children
G mos) dose) TATION Height Height mos) (in cm) kilos) Height
Age (Stunting) for Age (Stunting) for Age (Stunting)
(Wasting) (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
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
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 DATE OF AGE HEIGHT WEIGHT DEWORMING VIT A
No. of
DATE OF AGE HEIGHT WEIGHT
No. of
DATE OF AGE
HEIGHT
WEIGHT
No. of
Undernourished Undernourished (in Undernourished
WEIGHING (in mos) (in cm) (in kilos) (1st dose) SUPPLEMENTATION WEIGHING (in mos) (in cm) (in kilos) Weight for WEIGHING (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
Date of UPON ENTRY 90 DAYS AFTER 120 DAYS AFTER
NAME OF CHILDREN SEX REMARKS
Birth DATE OF AGE HEIGHT WEIGHT DEWORMING VIT A
NUTRITIONAL STATUS
No. of
DATE OF AGE HEIGHT WEIGHT
NUTRITIONAL STATUS
No. of
DATE OF AGE
HEIGHT
WEIGHT
NUTRITIONAL STATUS
No. of
SUPPLEMENTATION Undernourished Weight for Undernourished (in Weight for Undernourished
WEIGHING (in mos) (in cm) (in kilos) (1st dose) Weight for Height Height for Age WEIGHING (in mos) (in cm) (in kilos) Weight for Height for Age WEIGHING (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
DEPARTMENT OF SOCIAL WELFARE AND DEVELOPMENT
SUPPLEMENTARY 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
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
