Recording Form 1 - List of Female Learners

School-based Weekly Iron Folic Acid (WIFA) Supplementation

Region: VI Division : NEGROS OCCIDENTAL Reporting Month: JULY Date: July 23, 2018 School Year: 2018-2019
School ID: 302631 Name of School: FLORENTINA CAÑA RECTO MNHS-CALILING EXTENSION
Grade Level/Section: 7-A No. of Students Enrolled: 39 No. of Female Learners: 19 Address: Caliling, Cauayan, Negros Occidental

Provided With Iron Folic Acid Supplements

Consent* 1st Round 2nd Round
JULY AUGUST SEPTEMBER JANUARY FEBRUARY
No. NAME OF LEARNER
W1 W2 W3 W4 W5 W6 W1 W2 W3 W4
Y N
(date) (date) 7/23/2018 7/30/2018 8/6/2018 8/13/2018 8/20/2018 8/27/2018 9/3/2018 9/10/2018 9/17/2018 9/24/2018

1 ACHA, MADELYN G
2 ALQUIZA, JOYLYN L
3 BELNAS, ANDREA A
4 BIABADO, KYLA SHANE V
5 BISCAYNO, JELLIAN G
6 CUA, JOY-ANN A
7 DELA FRIZ, ALTHEA BIANCA M
8 DOCTO, CHERYL ANN L
9 DORIMON, ANA MAE G
10 GOMEZ, RESHA MAE S
11 HOSALLA, REANNE MAE E
12 IMPORTANTE, KIMBERLY T
13 MENDOZA, ERICA A
14 MOYA, JANLYN A
15 SAPINIT, DHEVERLYN JOY C
16 SAPINIT, MAE ANN L
17 SARENTAS, JUVELYN T
 18 VENDERCIN, CATHY JEAN N
19 YULO, DONITA T
20
21
22
23
24
25
TOTAL
*Consent given Administered by: Noted by:

SHEILA MAY V. DE ASIS 23-Jul-18

Class Adviser Date Grade Level Teacher Date
 Annex A1

8-2019

Occidental

MARCH
REMARKS
W5 W6
Reporting Form 2a–Classroom Level Annex A2

School-based Weekly Iron Folic Acid (WIFA) Supplementation

Round 1 Round 2 Reporting Month:__________________

Grade Level 7 8 9 10 ALS

Region: __VI_____________________ Division : _NEGROS OCCIDENTAL______________________ Date: _September 25, 2018_______

School Year: _2018-2019_____

School ID: _302631____ Name of School:FLORENTINA CAÑA RECTO MNHS-CALILING EXTENSION________________

Address: __Caliling, Cauayan, Negros Occidental___________

Enrollment Given WIFA Supplements Not Given WIFA Supp. Remarks

Total No. of
Section Total No. of Total No. of Female (Reasons why
Enrolled Female Number % Number %
Learners with WIFA is not given)
Learners Learners Consent

7A 38 19 19 19 100% 0 0% -

7B 39 24 24 24 100% 0 0% -

7C 35 18 18 18 100% 0 0% -

8A 51 24 23 23 96% 1 4% No Parent Consent

8B 50 25 20 20 80% 5 20% No Parent Consent

9A 40 20 15 15 75% 5 25% No Parent Consent

9B 41 24 16 16 67% 8 33% No Parent Consent

10A 38 21 16 16 76% 5 24% No Parent Consent

10B 37 21 21 21 100% 0 0% -

Total 369 196 172 172 87% 24 14%

Administered by: Noted by:

Class Adviser Grade Level Teacher

Date: _______________ Date: _______________

Reporting Form 2a–Classroom Level Annex A2

School-based Weekly Iron Folic Acid (WIFA) Supplementation

Round 1 Round 2 Reporting Month:_ JULY-SEPTEMBER, 2018_____

Grade Level 7 8 9 10 ALS

Region: __VI_____________________ Division : _NEGROS OCCIDENTAL______________________ Date: _September 25, 2018_______

School Year: _2018-2019_____

School ID: _302631____ Name of School:FLORENTINA CAÑA RECTO MNHS-CALILING EXTENSION________________

Address: __Caliling, Cauayan, Negros Occidental___________

Enrollment Given WIFA Supplements Not Given WIFA Supp. Remarks

Total No. of
Section Total No. of Total No. of Female (Reasons why
Enrolled Female Number % Number %
Learners with WIFA is not given)
Learners Learners Consent

7A 38 19 19 19 100% 0 0% -

Total 38 19 19 19 100% 0 0%
Administered by: Noted by:

SHEILA MAY V. DE ASIS

Class Adviser Grade Level Teacher

Date: __09/24/2018_______ Date: _______________

Reporting Form 2a–Classroom Level Annex A2

School-based Weekly Iron Folic Acid (WIFA) Supplementation

Round 1 Round 2 Reporting Month:_ JULY-SEPTEMBER, 2018_____

Grade Level 7 8 9 10 ALS

Region: __VI_____________________ Division : _NEGROS OCCIDENTAL______________________ Date: _September 25, 2018_______

School Year: _2018-2019_____

School ID: _302631____ Name of School:FLORENTINA CAÑA RECTO MNHS-CALILING EXTENSION________________

Address: __Caliling, Cauayan, Negros Occidental___________

Enrollment Given WIFA Supplements Not Given WIFA Supp. Remarks

Total No. of
Section Total No. of Total No. of Female (Reasons why
Enrolled Female Number % Number %
Learners with WIFA is not given)
Learners Learners Consent

7B 39 24 24 24 100% 0 0% -

Total 39 24 24 24 100% 0 0%
Administered by: Noted by:

JERELYN N. BELNAS
Class Adviser Grade Level Teacher

Date: __09/24/2018_______ Date: _______________

Reporting Form 2a–Classroom Level Annex A2

School-based Weekly Iron Folic Acid (WIFA) Supplementation

Round 1 Round 2 Reporting Month:_ JULY-SEPTEMBER, 2018_____

Grade Level 7 8 9 10 ALS

Region: __VI_____________________ Division : _NEGROS OCCIDENTAL______________________ Date: _September 25, 2018_______

School Year: _2018-2019_____

School ID: _302631____ Name of School:FLORENTINA CAÑA RECTO MNHS-CALILING EXTENSION________________

Address: __Caliling, Cauayan, Negros Occidental___________

Enrollment Given WIFA Supplements Not Given WIFA Supp. Remarks

Total No. of
Section Total No. of Total No. of Female (Reasons why
Enrolled Female Number % Number %
Learners with WIFA is not given)
Learners Learners Consent

7C 35 18 18 18 100% 0 0% -

Total 35 18 18 18 100% 0 0%
Administered by: Noted by:

KARMELLA ANN M. GOKI

Class Adviser Grade Level Teacher

Date: __09/24/2018_______ Date: _______________

Reporting Form 2a–Classroom Level Annex A2

School-based Weekly Iron Folic Acid (WIFA) Supplementation

Round 1 Round 2 Reporting Month:_ JULY-SEPTEMBER, 2018_____

Grade Level 7 8 9 10 ALS

Region: __VI_____________________ Division : _NEGROS OCCIDENTAL______________________ Date: _September 25, 2018_______

School Year: _2018-2019_____

School ID: _302631____ Name of School:FLORENTINA CAÑA RECTO MNHS-CALILING EXTENSION________________

Address: __Caliling, Cauayan, Negros Occidental___________

Enrollment Given WIFA Supplements Not Given WIFA Supp. Remarks

Total No. of
Section Total No. of Total No. of Female (Reasons why
Enrolled Female Number % Number %
Learners with WIFA is not given)
Learners Learners Consent

8A 51 24 23 23 96% 1 4% No Parent Consent

Total 51 24 23 23 96% 1 4%
Administered by: Noted by:

NIEVEN N. ARIB
Class Adviser Grade Level Teacher

Date: __09/24/2018_______ Date: _______________

Reporting Form 2a–Classroom Level Annex A2

School-based Weekly Iron Folic Acid (WIFA) Supplementation

Round 1 Round 2 Reporting Month:_ JULY-SEPTEMBER, 2018_____

Grade Level 7 8 9 10 ALS

Region: __VI_____________________ Division : _NEGROS OCCIDENTAL______________________ Date: _September 25, 2018_______

School Year: _2018-2019_____

School ID: _302631____ Name of School:FLORENTINA CAÑA RECTO MNHS-CALILING EXTENSION________________

Address: __Caliling, Cauayan, Negros Occidental___________

Enrollment Given WIFA Supplements Not Given WIFA Supp. Remarks

Total No. of
Section Total No. of Total No. of Female (Reasons why
Enrolled Female Number % Number %
Learners with WIFA is not given)
Learners Learners Consent

8B 50 25 20 20 80% 5 20% No Parent Consent

Total 50 25 20 20 80% 5 20%

Administered by: Noted by:

MARY ANN V. VILLARMA

Class Adviser Grade Level Teacher

Date: __09/24/2018_______ Date: _______________

Reporting Form 2a–Classroom Level Annex A2

School-based Weekly Iron Folic Acid (WIFA) Supplementation

Round 1 Round 2 Reporting Month:_ JULY-SEPTEMBER, 2018_____

Grade Level 7 8 9 10 ALS

Region: __VI_____________________ Division : _NEGROS OCCIDENTAL______________________ Date: _September 25, 2018_______

School Year: _2018-2019_____

School ID: _302631____ Name of School:FLORENTINA CAÑA RECTO MNHS-CALILING EXTENSION________________

Address: __Caliling, Cauayan, Negros Occidental___________

Enrollment Given WIFA Supplements Not Given WIFA Supp. Remarks

Total No. of
Section Total No. of Total No. of Female (Reasons why
Enrolled Female Number % Number %
Learners with WIFA is not given)
Learners Learners Consent

9A 40 20 15 15 75% 5 25% No Parent Consent

Total 40 21 15 15 75% 5 25%

Administered by: Noted by:

MA. LUZVI A. HAYAG

Class Adviser Grade Level Teacher

Date: __09/24/2018_______ Date: _______________

Reporting Form 2a–Classroom Level Annex A2

School-based Weekly Iron Folic Acid (WIFA) Supplementation

Round 1 Round 2 Reporting Month:_ JULY-SEPTEMBER, 2018_____

Grade Level 7 8 9 10 ALS

Region: __VI_____________________ Division : _NEGROS OCCIDENTAL______________________ Date: _September 25, 2018_______

School Year: _2018-2019_____

School ID: _302631____ Name of School:FLORENTINA CAÑA RECTO MNHS-CALILING EXTENSION________________

Address: __Caliling, Cauayan, Negros Occidental___________

Enrollment Given WIFA Supplements Not Given WIFA Supp. Remarks

Total No. of
Section Total No. of Total No. of Female (Reasons why
Enrolled Female Number % Number %
Learners with WIFA is not given)
Learners Learners Consent

9B 41 24 16 16 67% 8 33% No Parent Consent

Total 41 24 16 16 67% 8 33%

Administered by: Noted by:

LORENA D. VICENTE
Class Adviser Grade Level Teacher

Date: __09/24/2018_______ Date: _______________

Reporting Form 2a–Classroom Level Annex A2

School-based Weekly Iron Folic Acid (WIFA) Supplementation

Round 1 Round 2 Reporting Month:_ JULY-SEPTEMBER, 2018_____

Grade Level 7 8 9 10 ALS

Region: __VI_____________________ Division : _NEGROS OCCIDENTAL______________________ Date: _September 25, 2018_______

School Year: _2018-2019_____

School ID: _302631____ Name of School:FLORENTINA CAÑA RECTO MNHS-CALILING EXTENSION________________

Address: __Caliling, Cauayan, Negros Occidental___________

Enrollment Given WIFA Supplements Not Given WIFA Supp. Remarks

Total No. of
Section Total No. of Total No. of Female (Reasons why
Enrolled Female Number % Number %
Learners with WIFA is not given)
Learners Learners Consent

10A 38 21 16 16 76% 5 24% No Parent Consent

Total 38 21 16 16 76% 5 24%

Administered by: Noted by:

ERLYN L. AURINO
Class Adviser Grade Level Teacher

Date: __09/24/2018_______ Date: _______________

Reporting Form 2a–Classroom Level Annex A2

School-based Weekly Iron Folic Acid (WIFA) Supplementation

Round 1 Round 2 Reporting Month:_ JULY-SEPTEMBER, 2018_____

Grade Level 7 8 9 10 ALS

Region: __VI_____________________ Division : _NEGROS OCCIDENTAL______________________ Date: _September 25, 2018_______

School Year: _2018-2019_____

School ID: _302631____ Name of School:FLORENTINA CAÑA RECTO MNHS-CALILING EXTENSION________________

Address: __Caliling, Cauayan, Negros Occidental___________

Enrollment Given WIFA Supplements Not Given WIFA Supp. Remarks

Total No. of
Section Total No. of Total No. of Female (Reasons why
Enrolled Female Number % Number %
Learners with WIFA is not given)
Learners Learners Consent

10B 37 21 21 21 100% 0 0% -

Total 38 21 21 21 100% 0 0%
Administered by: Noted by:

DAISY R. ACABA
Class Adviser Grade Level Teacher

Date: __09/24/2018_______ Date: _______________

Reporting Form 2b – School Level Annex A2a

School-based Weekly Iron Folic Acid (WIFA) Supplementation

Round 1 Round 2 Reporting Month:_ July -September, 2018__

Grade Level 7 8 9 10 ALS

Region: ___VI____________________ Division : __NEGROS OCCIDENTAL_________________________

Date: _September 25, 2018_____School Year: _2018-2019_______

School ID: _302631____ Name of School:FLORENTINA CAÑA RECTO MNHS-CALILING EXTENSION____________

Address: __Caliling, Cauayan, Negros Occidental___________

Enrollment Given WIFA Supplements Not Given WIFA Supp. Remarks

Total No. of
Section Total No. of Total No. of Female (Reasons why
Enrolled Female Number % Number %
Learners with WIFA is not given)
Learners Learners Consent

7 112 61 61 61 100% 0 0

8 101 49 43 43 88% 6 12% No parent Consent

9 81 44 31 31 70% 13 30% No parent Consent

10 75 42 37 37 88% 5 12% No parent Consent

ALS 0 0 0 0 0 0 0

TOTAL 369 196 172 172 87% 24 14%

Submitted by: Noted by:

LORIBEL S. MONTAÑO RENE J. ANTENERO

School Principal District Supervisor
Date: _September 25, 2018________ Date: _______________

Validated By:

School Nurse
Form 3– District Level Annex A3
School-based Weekly Iron Folic Acid (WIFA) Supplementation
Round 1 Round 2 Reporting Month:_July -September, 2018__

Grade Level 7 8 9 10 ALS

School Year: __2018-2019_________ Date:_September 25, 2018____

Region: ______VI______________ Division : __NEGROS OCCIDENTAL_________________________ District: __CAUAYAN II_________

Enrollment Given WIFA Supp. Not Given WIFA Supp. Remarks

Total No. of
School ID School Total No. of Total No. of (Reasons why
Female
Enrolled Female Number % Number % WIFA is not
Learners with
Learners Learners given)
Consent

FLORENTINA CAÑA RECTO No Parent

1) 302631 369 196 172 172 87% 24 14%
MNHS-CALILING EXTENSION Consent

2)
3)
4)
5)
6)
7)
8)
9)
Total
Submitted by: Approved by:

LORIBEL S. MONTAÑO RENE J. ANTENERO

School Head / TIC District Supervisor
Date: September 25, 2018 Date: _______________
Validated By:
School Nurse
Form 4 - District level Annex A4
School-based Weekly Iron Folic Acid (WIFA) Supplementation
Round 1 Round 2 Reporting Month:__________________
Grade Level 7 8 9 10 ALS

Region: ____________ Date:__________________

Division: ________________
Enrolment
Given WIFA
Given WIFA Supp. Not Given WIFA
Total No. of Remarks
District Total No. of Total No. of Female (Reasons why WIFA is not given)
Enrolled Female Number % Number %
Learners with
Learners Learners Consent

Total
Submitted by: Approved by:

_______________________________________
Date Accomplished: ______________________ Schools Division Supervisor/ Superintendent
Validated by:

Division Nurse In-Charge

Form 5– Regional Level

School-based Weekly Iron Folic Acid (WIFA) Supplementation

Round 1 Round 2 Reporting Month:__________________
Grade Level 7 8 9 10 ALS

Region: __________________ Date:__________________

Enrolment Given WIFA Supplementation Not Given WIFA

Division Total No. of

Total No. of Total No. of Female Learners Number % Number %
Enrolled Learners Female Learners with Consent
 Total
Prepared by: Approved by: Noted by:

______________________________
WIFA Focal Person Director (BLSSD) HSD
Date Accomplished: Date Accomplished: Date Accomplished:
Annex A6

Remarks (Reasons why WIFA is not

given)