Department of Education

Bureau of Learner Support Services

SCHOOL HEALTH DIVISION
NUTRITIONAL STATUS REPORT OF ______________________Elem. School/ _________________District
Baseline (June) or Endline (March) SY ___________________

BODY MASS INDEX (BMI) HEIGHT-FOR-AGE (HFA) Pupils Take

Grade Pupils Weighed Height
Enrolment Severely Wasted Wasted Normal Overweight Obese Severely Stunted Stunted Normal Tall
Levels
No. % No. % No. % No. % No. % No. % No. % No. % No. % No. % No.
M
Kinder F
Total
M
Grade 1 F
Total
M
Grade 2 F
Total
M
Grade 3 F
Total
M
Grade 4 F
Total
M
Grade 5 F
Total
M
Grade 6 F
Total
M
SPED F
Total
M
GRAND
F
TOTAL:
Total
Note: The indicator used for below 6 years old is weight-for-age.
Prepared by: Noted:
pils Taken
Height
%
 NUTRITIONAL STATUS REPORT
________________________ELEM/ HIGH SCHOOL
Tarlac Province
Baseline SY 2019 -20

Date of Weighing: June 03, 2019 Kinder: Matapat

Birthday Weight Height Height 2 Age Body Mass
Names mm/dd/yyyy (kg) ( meters) Sex (m2) Index Nutritional Status Height-For-Age
y , m

Body Mass Index M F T HFA M F TOTAL Body Mass Index =

No. of Cases No. of Cases Weight (kgs)
Severely Wasted Sev. Stunted Height squred(m2)
 Wasted Stunted
Normal Normal
Overweight Tall
Obese
Prepared by:

sirronnie69@yahoo.com
 Republic o
Region III
SCHOOLS DIVISIO
BREAKDOWN OF SEVERELY WASTED
SCHOOL Y

DISTRICT Kinder Grade I Grade II Grade 3 Grade 4 Grade 5

Name of School BSEI ID Enrolment Sev. Wasted Wasted Sev. Wasted Wasted Sev. Wasted Wasted Sev. Wasted Wasted Sev. Wasted Wasted Sev. Wasted Wasted
M F M F M F M F M F M F M F M F M F M F M F M F

TOTAL 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
epublic of the Philippines
Region III - Central Luzon
S DIVISION OF TARLAC PROVINCE
WASTED, WASTED AND SEVERELY STUNTED PUPILS
CHOOL YEAR : 2019-2020

Grade 6 SPED TOTAL Kinder I 2 3 4 5 6 SPED

Sev. Wasted Wasted Sev. Wasted Wasted Severely Wasted Wasted SW+W SEVERELY STUNTED
M F M F M F M F M F T M F T TOTAL M F M F M F M F M F M F M F M F
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
 TOTAL
M F TOTAL
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
Breakdown of Severely Wasted and Wasted Pupils
SY 2019-2020

DISTRICT NO. OF SEVERELY WASTED PUPILS NO. OF WASTED PUPILS

Name of School BSEI ID Enrolment Kinder Grade Grade Grade Grade Grade Grade SPED TOTAL Kinder Grade Grade Grade Grade Grade Grade SPED
I II III IV V VI I II III IV V VI

TOTAL
 GRAND TOTAL
TOTAL SW+W