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: _________________________

BMI Nutritional Parent's

Date of Participatio
Age in for 6 Dewormed consent
No. Name Sex Grade/ Date of Birth Weighing /
Years /
Weight Height
y.o. Status (NS) ? for milk?
n in 4Ps
Section (MM/DD/YYYY) Measuring (Kg) (cm) (yes or
(MM/DD/YYYY) Months and (yes or no)
no)
above (yes or no)
BMI-A HFA

Prepared by: Approved by:

__________________________________ 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
SBFP in
Previous
Years (yes or
no)
SBFP Form 2 (2021)
Region IX

SCHOOL-BASED FEEDING PROGRAM (SBFP) SUMMARY OF BENEFICIARIES & START OF FEEDING (SY 2020-20
Division/Province: ZAMBOANGA DEL NORTE
City/ Municipality/Barangay : POBLACION, SINDANGAN
Name of School / School District : SINDANGAN SPECIAL EDUCATION CENTER
School ID Number: 195536
Date of Start of Feeding: SEPTEMBER 18, 2023
Last Mile School: ___Y ___N
Nutritional Status at Start/End of Feeding No. of Secondary Targets No. of 4
Learners
SW W N OW+O SS S N T No. of Pupils- No. of No. of No. of Dewormed
Number of Undernourished at-risk-of- Stunted/ Indigent Indigenous
School Children by Grade Level dropping-out Severely Learners Peoples
(PARDOs) Stunted (IPs)

1. Kinder 13 3 0 0 13 3 0 0

2. Grade I 6 5 0 0 6 5 0 0

3. Grade II 0 3 0 0 0 3 0 0

4. Grade III 0 4 0 0 0 4 0 0

5. Grade IV 0 2 0 0 0 2 0 0

6. Grade V 0 4 0 0 0 4 0 0

7. Grade VI 1 2 0 0 1 2 0 0

8. None Graded 5 8 0 0 5 8 0 0

Total 25 31 0 0 25 31 0 0

Prepared by: Approved by:

 MINDALYN M. ARIP ARIEL B. CRAMPATANTA EdD
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
BLSS-SHD
FEEDING (SY 2020-2021)

No. of 4 Ps No. of Pupils Date Feeding

Beneficiarie who are Started/Ended
s beneficiaries
in previous
years
(Repeaters)
NTA EdD

nal compilation by the RO, for submission to DepEd

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

FOR THE MONTH OF ______________________ , SY _____________

Region ____________________________
Division ___________________________ School: _____________________________________
District ___________________________ Grade: __________ Section _____________________
School ID Number: _________________________
NAME OF PUPIL ACTUAL FEEDING

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
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:
Prepared by:
 __________________________
B. Deworming D. Actual Feeding
Feeding Teacher / School Nurse
( x ) - not dewormed (H ) - Present, served with Hot meals
Approved by: ( √ ) - dewormed (M ) - Present, served with Milk
(H/M ) - Present, served with Hot meals & Milk
( A ) - Absent, not served
School Head (H2/M2/(H/M2)) - Present, served twice

Note: This form shall be prepared by the school to be consolidated using the Revised OKD Form A.
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 53 54 55 56
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

(H ) - Present, served with Hot meals

(M ) - Present, served with Milk
(H/M ) - Present, served with Hot meals & Milk
( A ) - Absent, not served
(H2/M2/(H/M2)) - Present, served twice

page 2
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 93 94 95 96
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

(H ) - Present, served with Hot meals

(M ) - Present, served with Milk
(H/M ) - Present, served with Hot meals & Milk
( A ) - Absent, not served
(H2/M2/(H/M2)) - Present, served twice

page 3
97 98 99 100

page 3
 SBFP Form 3 (2021)

SCHOOL-BASED FEEDING PROGRAM

FOR THE MONTH OF ______________________ , SY _____________

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

ACTUAL FEEDING
ATTENDANCE
NAME OF PUPIL No. of No. of
Days Feeding
Present Days
101 102 ### 104 105 ### ### ### ### ### ### 112 113 114 115 116 117 118 119 120 (A) (B)
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: AVERAGE:

page 4
 D. Actual Feeding

(H ) - Present, served with Hot meals

(M ) - Present, served with Milk
(H/M ) - Present, served with Hot meals & Milk
( A ) - Absent, not served
(H2/M2/(H/M2)) - Present, served twice

page 4
ATTENDANCE

Percentage

(A/B)*100

page 4
SBFP Form 5 (2020)

DEPARTMENT OF EDUCATION
Region ____

REGION/DIVISION/DISTRICT: ____________________________________________________________________
NAME OF SCHOOL: ____________________________________________________________________
SCHOOL ID NO.: ____________________________________________________________________

SCHOOL-BASED FEEDING PROGRAM - MILK COMPONENT

LIST OF AUTHORIZED CONSIGNEES (SY________)

NAME & DESIGNATION TEL. NO. MOBILE NO. EMAIL ADD SPECIMEN
SIGNATURE
1 (School Head)

2 (School Feeding Coordinator)

3 (School Property Custodian)

SCHOOL INSPECTION TEAM (SY________)

NAME & DESIGNATION TEL. NO. MOBILE NO. EMAIL ADD SPECIMEN
SIGNATURE
1

3
SBFP Form 5 (2020)

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

SBFP Form 5 (2021)

DEPARTMENT OF EDUCATION
Region ___

REGION/DIVISION/DISTRICT: ______________________________________________________________________________
NAME OF SCHOOL: ______________________________________________________________________________
SCHOOL ID NO.: ______________________________________________________________________________

SCHOOL-BASED FEEDING PROGRAM - MILK COMPONENT

LIST OF BENEFICIARIES (SY________)

Classification of Students in terms of Milk Tolerance
(Please check one)
Without milk With milk Not allowed by
intolerance and intolerance but parents to
Name Grade & Section will participate in willing to participate in
milk feeding participate in milk milk feeding
feeding
SBFP Form 5 (2021)

Prepared by: APPROVED BY:

School Feeding Coordinator School Head

SBFP Form 6 (2021)

DEPARTMENT OF EDUCATION
Region ___

REGION/DIVISION/DISTRICT: ______________________________________________________________________________
NAME OF SCHOOL: ______________________________________________________________________________
SCHOOL ID NO.: ______________________________________________________________________________

SCHOOL-BASED FEEDING PROGRAM

NFP DELIVERIES (SY________)

Grade Level Number of Date No. of Packs Received No. of Packs for Remarks
Beneficiaries Delivered Replacement/
New Replacemen Total (New + Rejected
t Replacement)
Kinder
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
TOTAL:

MILK DELIVERIES (SY________)

Grade Level Number of Date No. of Packs Received No. of Packs for Remarks
Beneficiaries Delivered Replacement/
New Replacemen Total (New + Rejected
t Replacement)
Kinder
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
TOTAL:
SBFP Form 6 (2021)

Prepared by: APPROVED BY:

School Feeding Coordinator School Head