Scribd Logo
Upload

Welcome to Scribd!

  • 193 views

    Wifa Forms

    Uploaded by

    giareysie
    This document contains forms for recording the administration of weekly iron and folic acid supplements to students. The first section is a classroom-level form that collects the names of students, whether they have consent to receive the supplements, and dates that supplements were administered over four weeks in two rounds. The second section collects school-level data on enrollment numbers, number of female students, and the number and percentage of students given the supplements.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd

    Wifa Forms

    Uploaded by

    giareysie
    193 views9 pages
    This document contains forms for recording the administration of weekly iron and folic acid supplements to students. The first section is a classroom-level form that collects the names of students, whether they have consent to receive the supplements, and dates that supplements were administered over four weeks in two rounds. The second section collects school-level data on enrollment numbers, number of female students, and the number and percentage of students given the supplements.

    Original Description:

    wifa

    Copyright

    © © All Rights Reserved

    Available Formats

    XLSX, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    This document contains forms for recording the administration of weekly iron and folic acid supplements to students. The first section is a classroom-level form that collects the names of students, whether they have consent to receive the supplements, and dates that supplements were administered over four weeks in two rounds. The second section collects school-level data on enrollment numbers, number of female students, and the number and percentage of students given the supplements.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Download as xlsx, pdf, or txt
    193 views9 pages

    Wifa Forms

    Uploaded by

    giareysie
    This document contains forms for recording the administration of weekly iron and folic acid supplements to students. The first section is a classroom-level form that collects the names of students, whether they have consent to receive the supplements, and dates that supplements were administered over four weeks in two rounds. The second section collects school-level data on enrollment numbers, number of female students, and the number and percentage of students given the supplements.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Download as xlsx, pdf, or txt
    You are on page 1of 9

    Form 1 – Classroom Level Annex A1

    School-based Weekly Iron Folic Acid (WIFA) Supplementation

    Region: Division : Date: School Year:


    School ID: _____________ Name of School: Address:
    Grade Level/Section: ______________________ Number of Students Enrolled: Number of Female Learners: ______________
    Round 1 Round 2

    LRN Consent Provided With Iron Folic Acid Supplements REMARKS

    Name of Learner

    With Without Month of ___________ Month of ___________ Month of ____________


    Consent Consent W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4
    Indicate date Indicate date Indicate date Indicate date Indicate date Indicate date Indicate date Indicate date Indicate date Indicate date Indicate date Indicate date

    1
    2
    3
    4
    5
    6
    7
    8
    9
    10
    11
    12
    13
    14
    15
    TOTAL
    Administered by: Noted by:

    Class Adviser Grade Level Chair


    Date: Date:
    Form 1 – Classroom Level Annex A1

    School-based Weekly Iron Folic Acid (WIFA) Supplementation

    Region: Division : Date: School Year:


    School ID: _____________ Name of School: Address:
    Grade Level/Section: ______________________ Number of Students Enrolled: Number of Female Learners: ______________
    Round 1 Round 2

    LRN Consent Provided With Iron Folic Acid Supplements REMARKS

    Name of Learner

    With Without Month of ___________ Month of ___________ Month of ____________


    Consent Consent W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4
    Indicate date Indicate date Indicate date Indicate date Indicate date Indicate date Indicate date Indicate date Indicate date Indicate date Indicate date Indicate date

    16
    17
    18
    19
    20
    21
    22
    23
    24
    25
    26
    27
    28
    29
    30
    TOTAL
    Administered by: Noted by:

    Class Adviser Grade Level Chair


    Date: Date:

    Form 1 – Classroom Level Annex A1

    School-based Weekly Iron Folic Acid (WIFA) Supplementation

    Region: Division : Date: School Year:


    School ID: _____________ Name of School: Address:
    Grade Level/Section: ______________________ Number of Students Enrolled: Number of Female Learners: ______________
    Round 1 Round 2

    LRN Consent Provided With Iron Folic Acid Supplements REMARKS

    Name of Learner

    With Without Month of ___________ Month of ___________ Month of ____________


    Consent Consent W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4
    Indicate date Indicate date Indicate date Indicate date Indicate date Indicate date Indicate date Indicate date Indicate date Indicate date Indicate date Indicate date

    31
    32
    33
    34
    35
    36
    37
    38
    39
    40
    41
    42
    43
    44
    45
    TOTAL
    Administered by: Noted by:
    Class Adviser Grade Level Chair
    Date: Date:
    Form 1 – Classroom Level

    School-based Weekly Iron Folic Acid (WIFA) Supplemen

    Round 1 Round 2 Grade 7 Grade 8 Grdae 9

    Region: _______________________________Division : ______________________________ District : ________________

    GRADE LEVEL /ENROLLMENT GIVEN WIFA NOT GIVEN WIFA


    SUPPLEMENTS SUPPLEMENTS
    TOTAL NUMBER TOTAL NUMBER NUMBER % NUMBER
    OF ENROLLED OF FEMALE
    STUDENTS STUDENTS
    GRADE 7
    GRADE 8
    GRADE 9
    GRADE 10
    ALS

    TOTAL
    Submitted by:
    Noted by:
    School Principal
    Date: District Super
    Date:

    Validated
    Annex A2

    Acid (WIFA) Supplementation

    Grade 10 ALS School Year ; _______________

    strict : ________________________

    NOT GIVEN WIFA REMARKS


    SUPPLEMENTS ( Reason why WIFA not given)
    %

    District Supervisor
    Form 1 – Classroom Level

    School-based Weekly Iron Folic Acid (WIFA) Supp

    Region: Division :
    School ID: _____________ Name of School:
    Grade Level/Section: ______________________ Number of Students Enrolled:
    Round 1 Round 2

    SCHOOL ID NAME OF SCHOOL /ENROLLMENT GIVEN WIFA


    SUPPLEMENTS
    TOTAL NUMBER TOTAL NUMBER NUMBER %
    OF ENROLLED OF FEMALE
    STUDENTS STUDENTS
    1
    2
    3
    4
    5
    6
    7
    8
    9
    10
    11
    12
    TOTAL
    Submitted by:
    Noted by:
    District Nutrition Coordinator
    Date:

    Validated
    Annex A3

    n Folic Acid (WIFA) Supplementation

    Date: School Year:


    Address:
    Number of Female Learners: ______________

    NOT GIVEN WIFA REMARKS


    SUPPLEMENTS ( Reason why WIFA not given)
    NUMBER %

    oted by:

    District Supervisor
    Date:
    ___________

    You might also like