SFP Form 2.

a
DEPARTMENT OF SOCIAL WELFARE AND DEVELOPMENT
FIELD OFFICE XII
SUPPLEMENTARY FEEDING PROGRAM SY 2023-2024
MUNICIPALITY OF PALIMBANG

MASTERLIST OF BENEFICIARIES

Name of CDC: ______________________________________________________

Name of CDW: _______________________________________________________
Location:

4 P's Child of Solo

Birthdate Date of Weighing
No. Household ID No. NAME OF CHILD (Surname, First Name Middle Name) Sex Age in Months Weight (kg) *Status Height (cm) **Status Ethnicity Disability Beneficiaries Parent NAME OF PARENT/GUARDIAN
(mm/dd/yyyy) (mm/dd/yyyy)
( YES/NO ) (YES/NO)

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This form shall be used by the CDW in determining the final list of children to be included in the feeding, it should be updated and finalized before the actual feeding.
*Nutritional Status weight for age: SUW (Severely Underweight), UW (Underweight), N (Normal), OW (Overweight)
**Nutritional Status Height for age: SS ( Severely Stunted), S(Stunted), N (Normal), T (tall)
No. of Beneficiaries by Age Male Female Male Female Total

2 yo No. of 4 P's Beneficiaries

3 yo No. of IP Children

4 yo No. of Children w/ Disability

5 yo Number of Children w/ Solo Parent
Total

Prepared by: Noted by: Approved by:

Child Development Worker (CDW) Brgy. Captain Municipal Social Welfare and Development Officer
Date: Date: Date:
SFP Form 3.a.1
DEPARTMENT OF SOCIAL WELFARE AND DEVELOPMENT
FIELD OFFICE XII
SUPPLEMENTARY FEEDING PROGRAM SY 2023-2024
MUNICIPALITY OF PALIMBANG
CHILD DEVELOPMENT CENTER LEVEL

Name of Child Development Center (CDC): _____________________________________________

Name of Child Development Worker (CDW):______________________________________________
Location:
UPON ENTRY/BASELINE 1 Month After
NAME OF CHILD (Surname, First Name, Middle ***Vit. A
# Name)
Sex Birthdate (mm/dd/yyyy) Age Weight Height ***Deworming Date of Weighing Age Weight Remarks
Date of Weighing (mm/dd/yyyy) *Status **Status Supplementation *Status
(in mos.) (in kg.) (in cm.) (1st Dose) (mm/dd/yyyy) (in mos.) (in kg.)
(1st Dose)

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This form shall be used every month by the CDW in recording weight and height of the child to determine the improvement in child's nutritional status *(Weight for ** (Height for
Male Female Male Female *(Weight for Age): Male Female
Age): Age):
*Nutritional Status weight for age: SUW (Severely Underweight), UW (Underweight), N (Normal), OW (Overweight)

**Nutritional Status Height for age: SS ( Severely Stunted), S(Stunted), N (Normal), T (tall) N N N

*** DCW should indicate date or month & year when the child was dewormed & provided Vit. A UW S UW

SUW SS SUW

OW T OW

Total Total Total

Prepared by: Noted by: Approved by:

Child Development Worker (CDW) Brgy. Captain Municipal Social Welfare and Development Officer (MSWDO)
Date: Date: Date:
SFP Form 3.a.2
DEPARTMENT OF SOCIAL WELFARE AND DEVELOPMENT
FIELD OFFICE XII
SUPPLEMENTARY FEEDING PROGRAM SY 2019-2020
MUNICIPALITY OF PALIMBANG
CHILD DEVELOPMENT CENTER LEVEL
WEIGHT MONITORING FORM

Name of Child Development Center (CDC): _____________________________________________

Name of Child Development Worker (CDW): ______________________________________________
Location:
2 Months After 3 Months After 4 Months After

NAME OF CHILD Birthdate

# Sex Date of Weighing Age (in Weight Date of Weighing Age (in Weight (in Height Date of Weighing Age (in Weight (in
Remarks
(Surname, First Name, Middle Name) (mm/dd/yyyy) *Status *Status **Status *Status
(mm/dd/yyyy) mos.) (in kg.) (mm/dd/yyyy) mos.) kg.) (in cm.) (mm/dd/yyyy) mos.) kg.)

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This form shall be used every month by the CDW in recording weight and height of the child to determine the improvement in child's nutritional
** (Height Male Female *(Weight for
status *(Weight for Age): Male Female *(Weight for Age): Male Female Male Female
for Age): Age):
*Nutritional Status weight for age: SUW (Severely Underweight), UW (Underweight), N (Normal), OW (Overweight)
**Nutritional Status Height for age: SS ( Severely Stunted), S(Stunted), N (Normal), T (tall) N N N N
*** DCW should indicate date or month & year when the child was dewormed & provided Vit. A UW UW S UW
SUW SUW SS SUW
OW OW T OW
Total Total Total Total

Prepared by: Noted by: Approved by:

Child Development Worker (CDW) Brgy. Captain Municipal Social Welfare and Development Officer (MSWDO)
Date: Date: Date:
SFP Form 3.a.3
DEPARTMENT OF SOCIAL WELFARE AND DEVELOPMENT
FIELD OFFICE XII
SUPPLEMENTARY FEEDING PROGRAM SY 2018-2019
MUNICIPALITY OF PALIMBANG
CHILD DEVELOPMENT CENTER LEVEL
WEIGHT MONITORING FORM
Name of Child Development Center (CDC): __________________________________________
Name of Child Development Worker (CDW): _________________________________________
Location:

5 Months After 6 Months After

NAME OF CHILD (Surname, Birthdate

# Sex Remarks
First Name, Middle Name) (mm/dd/yyyy)

Age (in Weight Date of Weighing Age Weight (in Height *Deworming **Vit. A Supplementation
Date of Weighing (mm/dd/yyyy) *Status *Status *Status
mos.) (in kg.) (mm/dd/yyyy) (in mos.) kg.) (in cm.) (2nd Dose) (2nd Dose)

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This form shall be used every month by the CDW in recording weight and height of the child to determine the improvement in child's nutritional
status *(Weight for *(Weight for ** (Height for
Male Female Male Female Male Female
Age): Age): Age):
*Nutritional Status weight for age: SUW (Severely Underweight), UW (Underweight), N (Normal), OW (Overweight)
**Nutritional Status Height for age: SS ( Severely Stunted), S(Stunted), N (Normal), T (tall) N N N
*** DCW should indicate date or month & year when the child was dewormed & provided Vit. A UW UW S
SUW SUW SS
OW OW T
Total Total Total
Prepared by: Noted by: Approved by:

Child Development Worker (CDW) Brgy. Captain Municipal Social Welfare and Development Officer (MSWDO)
Date: Date: Date:
SFP Form 4.0
DEPARTMENT OF SOCIAL WELFARE AND DEVELOPMENT
FIELD OFFICE XII
SUPPLEMENTARY FEEDING PROGRAM SY 2022-2023
DAILY FOOD ACCEPTANCE AND ATTENDANCE

NAME OF CHILD DEVELOPMENT CENTER (CDC): LEGEND: A - ABSENT

NAME OF DAY CARE WORKER (CDW): / - PRESENT
LOCATION: X - ABSENT BUT GIVEN HOT MEAL

ACTUAL FEEDING
# NAME OF CHILD SEX Date

Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

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Prepared by: Noted by: Approved by:

Child Development Worker (CDW) Brgy. Captain Municipal Social Welfare and Development Officer (MSWDO)
Date: Date: Date:
SFP Form 4.0
DEPARTMENT OF SOCIAL WELFARE AND DEVELOPMENT
FIELD OFFICE XII
SUPPLEMENTARY FEEDING PROGRAM SY 2018-2019
DAILY FOOD ACCEPTANCE AND ATTENDANCE

NAME OF CHILD DEVELOPMENT CENTER (CDC): LEGEND: A - ABSENT

NAME OF DAY CARE WORKER (CDW): / - PRESENT
LOCATION: X - ABSENT BUT GIVEN HOT MEAL

ACTUAL FEEDING
# NAME OF CHILD SEX Date

Day 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40
1

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Prepared by: Noted by: Approved by:

Child Development Worker (CDW) Brgy. Captain Municipal Social Welfare and Development Officer (MSWDO)
Date: Date: Date:
SFP Form 4.0
DEPARTMENT OF SOCIAL WELFARE AND DEVELOPMENT
FIELD OFFICE XII
SUPPLEMENTARY FEEDING PROGRAM SY 2018-2019
DAILY FOOD ACCEPTANCE AND ATTENDANCE

NAME OF CHILD DEVELOPMENT CENTER (CDC): LEGEND: A - ABSENT

NAME OF DAY CARE WORKER (CDW): / - PRESENT
LOCATION: X - ABSENT BUT GIVEN HOT MEAL

ACTUAL FEEDING
# NAME OF CHILD SEX Date

Day 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60

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Prepared by: Noted by: Approved by:

Child Development Worker (CDW) Brgy. Captain Municipal Social Welfare and Development Officer (MSWDO)
Date: Date: Date:
SFP Form 4.0
DEPARTMENT OF SOCIAL WELFARE AND DEVELOPMENT
FIELD OFFICE XII
SUPPLEMENTARY FEEDING PROGRAM SY 2018-2019
DAILY FOOD ACCEPTANCE AND ATTENDANCE

NAME OF CHILD DEVELOPMENT CENTER (CDC): LEGEND: A - ABSENT

NAME OF DAY CARE WORKER (CDW): / - PRESENT
LOCATION: X - ABSENT BUT GIVEN HOT MEAL
ACTUAL FEEDING
# NAME OF CHILD SEX Date
Day 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80

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Prepared by: Noted by: Approved by:

Child Development Worker (CDW) Brgy. Captain Municipal Social Welfare and Development Officer (MSWDO)
Date: Date: Date:
SFP Form 4.0
DEPARTMENT OF SOCIAL WELFARE AND DEVELOPMENT
FIELD OFFICE XII
SUPPLEMENTARY FEEDING PROGRAM SY 2018-2019
DAILY FOOD ACCEPTANCE AND ATTENDANCE

NAME OF CHILD DEVELOPMENT CENTER (CDC): LEGEND: A - ABSENT

NAME OF DAY CARE WORKER (CDW): / - PRESENT
LOCATION: X - ABSENT BUT GIVEN HOT MEAL
ACTUAL FEEDING
# NAME OF CHILD SEX Date
Day 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100

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Prepared by: Noted by: Approved by:

Child Development Worker (CDW) Brgy. Captain Municipal Social Welfare and Development Officer (MSWDO)
Date: Date: Date:
SFP Form 4.0
DEPARTMENT OF SOCIAL WELFARE AND DEVELOPMENT
FIELD OFFICE XII
SUPPLEMENTARY FEEDING PROGRAM SY 2018-2019
DAILY FOOD ACCEPTANCE AND ATTENDANCE

NAME OF CHILD DEVELOPMENT CENTER (CDC): LEGEND: A - ABSENT

NAME OF DAY CARE WORKER (CDW): / - PRESENT
LOCATION: X - ABSENT BUT GIVEN HOT MEAL
ACTUAL FEEDING
# NAME OF CHILD SEX Date
Day 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120

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Prepared by: Noted by: Approved by:

Child Development Worker (CDW) Brgy. Captain Municipal Social Welfare and Development Officer (MSWDO)
Date: Date: Date: