Bns Form

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PPAN-IG No.

009
Form No. 01, Page 1 of 4 pages
Revised February 2011
RATING SHEET FOR EVALUATING THE PERFORMANCE
OF BARANGAY NUTRITION SCHOLARS
For the period ______________ 20 __

Name of BNS ________________________________________


Date of Birth _________________________________________ RATING:
Date of Training ______________________________________ 85 - 100
Educational Attainment ________________________________ 70-84 - Satisfactor
Barangay ___________________________________________ 55-69 - Unsatisfac
Municipality ________________________________________ 54 and below - Very Un
Province/City ________________________________________
Period of Service______________________________________

INSTRUCTIONS:
1. This performance rating sheet is applicable to the availment of second grade Civil Service eligibility, and the annual search for Outstanding
2. Accomplish the form every twelve months (one year) of continuous service of the BNS. The inclusive period of service of the BNS as indica
above may differ if the BNS is being considered for both. For the Outstanding BNS Award, the period of service is January to December of
year. For Civil Service eligibility, the period of service may vary, as long as it covers a period of 2 years continuous satisfactory service.
3. In rating, rate the yearly accomplishments of the BNS against the targets set in the BNS action plan.
4. In filling up the forms, determine the accomplishment per task/activity of the BNS being evaluated. Give corresponding scores to each
accomplishment per task/activity and indicate these under column "Actual Score". Fill up the column "Remarks" when necessary to explain
of accomplishments. Add up the actual scores and place a check (/) on the appropriate rating of the BNS performance.

Score of Accomplishment 1/
Task/Activity Quality Actual
Percent
Accomplishment Score

I. IDENTIFYING AND LOCATING TARGETS


(35 points)
81 & above 10.0
A. Weighing of children, 0-71 months 61 - 80 8.0
a. total number of preschoolers weighed ______________ 41 - 60 6.0
b. total preschool population 2/ ______________ 21 - 40 4.0
c. % accomplishment = (a) x 100 ______________ 1 - 20 2.0
(b)

B. Follow-up weighing of children, 0-24 months old 3/ ___ 4/ ___ ___


Mo.1 Mo.2 Mo.3
a. total number of children weighed per month ___ ___ ___ 90 & above 10.0
over (/) the total no. of 0-24 months old Mo.4 Mo.5 Mo.6 80 - 89 9.0
infants identified by full weighing excluding ___ ___ ___ 70 - 79 8.0
those who have graduated/transferred. Mo.7 Mo.8 Mo.9 60 - 69 7.0
___ ___ ___ 50 - 59 6.0
Mo.10 Mo.11 Mo.12 40 - 49 5.0
b. % accomplishment (a x 100) 30 - 39 4.0
= % monthly accomplishment __________ % 20 - 29 3.0
c. total % accomplishment (add all % monthly 10 - 19 2.0
accomplishments) __________ % 9 & below 1.0
d. average monthly accomplishment = (c) ÷ 12 __________ %

1/ The accomplishment for this and all tasks should be given the corresponding scores as provided under the column Score.
2/ Per DOH-Administrative Order No. 25 Series 2003 dated 3 March 2003, all children aged 0-71 months (at least 17.5% of total population) s
be weighed.
For areas with more than 2,000 preschoolers like cities and NCR areas, the following scoring system could be used for 1.A c:
81 and above 10.0
61 - 80 8.0
31 - 60 6.0
21 - 30 4.0
1 - 20 2.0
3/ All children, 0-24 months old should be weighed monthly. In cases where there are too many infants, the local nutrition committee could pr
that a certain proportion of these infants should be weighed monthly, but the number of infants should not be less than 200.
4/ Mo. 1 refers to lst mo. service of BNS; Mo. 2 to his/her 2nd mo. of service, etc.
PPAN-IG No. 009
Form No. 01, Page 2 of 4 pages
Score of Accomplishment 1/
Task/Activity Quality Actual
Percent
Accomplishment Score
C. Follow-up weighing of 25-71 months old
preschoolers 5/
6/

a. total number of 25-71 months old _____ 1st Qtr 90 & above 10.0
preschoolers weighed ÷ total number of 25-71 _____ 2nd Qtr 80 - 89 9.0
months old preschoolers identified by full _____ 3rd Qtr 70 - 79 8.0
weighing excluding those who have _____ 4th Qtr 60 - 69 7.0
graduated or transferred. 50 - 59 6.0
40 - 49 5.0
b. % accomplishment (a x 100) 30 - 39 4.0
= % quarterly accomplishment __________ % 20 - 29 3.0
c. total % accomplishment (add all % quarterly 10 - 19 2.0
accomplishment) __________ % 9 & below 1.0
d. average quarterly accomplishment = (c) ÷ 4 __________ %

D. Follow-up weighing of underweight and


severely underweight preschoolers ___ 4/ ___ ___
Mo.1 Mo.2 Mo.3
a. total number of underweight and severely ___ ___ ___ 90 & above 5.0
underweightpreschoolers weighed ÷ total number Mo.4 Mo.5 Mo.6 80 - 89 4.5
of underweight and severely underweight ___ ___ ___ 70 - 79 4.0
preschoolers identified by full weighing excluding Mo.7 Mo.8 Mo.9 60 - 69 3.5
those who have graduated transferred. ___ ___ ___ 50 - 59 3.0
Mo.10 Mo.11 Mo.12 40 - 49 2.5
b. % accomplishment (a x 100) 30 - 39 2.0
= % monthly accomplishment __________ % 20 - 29 1.5
c. total % accomplishment (add all % monthly 10 - 19 1.0
accomplishment) __________ % 9 & below 0.5
d. average monthly accomplishment = (c) ÷ 12 __________ %

II. DELIVERY OF BASIC SERVICES


(30 points)
A. Provision of basic nutrition information &
promotion of sanitary waste disposal and clean
environment through home visits 7/
a. number of targeted families visited within the ____________ 81 & above 5.0
year 8/ 61-80 4.0
b. number of families targeted for home visits 41-60 3.0
during the year ____________ 21-40 2.0
c. % accomplishment = (a) x 100 __________ % 20 & below 1.0
(b)
B. Organization/revitalization of parents organization
for mothers'/parents' classes
a. number of mothers/parents organized during 81 & above 5.0
the year ____________ 61 - 80 4.0
b. number of mothers/parents targeted to be 41 - 60 3.0
organized within the year ____________ 21 - 40 2.0
c. % accomplishment = (a) x 100 __________ % 20 & below 1.0
(b)
C. Distribution of food/dietary supplements 9/
a. number of recipients provided food/dietary 81 & above 5.0
supplements ____________ 61 - 80 4.0
b. total number of target recipients to be reached 41 - 60 3.0
within the year ____________ 21 - 40 2.0
c. % accomplishment = (a) x 100 __________ % 20 & below 1.0
(b)
5/ All 25 - 71 months old preschoolers should be weighed quarterly regardless of nutritional status (based on DOH-Administrative Order 25 Series 2003).
6/ 1st Quarter refers to the first 3 months of weighing by BNS; 2nd Quarter to next 3 months of weighing, etc.
7/ Nutrition information dissemination includes giving of advice on infant feeding, meal management, wise buying, etc., and demonstrations on proper utiliza
available food commodities, proper preparation of complementary foods from the family pot, family planning, etc..
8/ This refers to the individual families reached. A family may refer to the mother and child/children. If the family is visited twice, thrice or even 12 times
within the year, this same family should be counted only once.
9/ This applies to food/dietary supplements from local government units, NGOs or other sources.

PPAN-IG No. 009


Form No. 01, Page 4 of 4 pages
Task/Activity Quality Score of Accomplishment 1/ Actual
Percent
Accomplishment Score

IV. TIMELINESS OF SUBMISSION OF


REPORTS (10 points)
(Reports are submitted on time or on prescribed
schedule)

a. BNS Action Plan (check and give 1 point


if available and countersigned by NAO) ____________ ____________ 1.0 _____

b. Monthly Accomplishment Report


No. submitted on time signed by NAO ____________
Percent submission __________ % 81 & above 3.0 _____
c. Quarterly Weighing Report of 25 - 71 months 61 - 80 2.5 _____
old preschoolers, countersigned by NAO 41 - 60 2.0 _____
No. submitted on time ____________ 21 - 40 1.5 _____
Percent submission __________ % 20 & below 1.0 _____
d. Monthly Weighing Reports of 0-24 month old
(infants,) countersigned by NAO
No. submitted on time ____________
Percent submission __________ %

Task/Activity Score Actual Score Remarks

V. ADDITIONAL POINTS (5 points)

a. Conduct of full weighing of 0-71 months old


preschoolers twice within the year 1 _______

b. Assistance provided in organization/


revitalization of the Barangay Nutrition 1 _______
Committee

c. Presence of Barangay Nutrition Office or 0.5 _______


BNS Office

d. Ability to explain the causes of malnutrition 0.5 _______


in the barangay

e. Established network with other organizations 1 _______


to assist in the monthly/quarterly weighing 12/

f. Attendance to 5 or more trainings/seminars/ 1 _______


orientations on nutrition and related
activities/13

12/
Organizations include civic groups (i.e. youth organization, senior citizens, Red Cross, Rotary Club), religious and school (i.e. Girl Sc
could possibly assist in the conduct of weighing.
/13
Attendance to trainings/seminars/orientations during the evaluation year should be supported by certificates of attendance.
ACCOMPLISHED BY: ATTESTED BY:

Name and Signature Name and Signature

Designation /Agency Designation/Agency

Date : ______________
RATING:
- Very Satisfactory
70-84 - Satisfactory
55-69 - Unsatisfactory
54 and below - Very Unsatisfactory

nt of second grade Civil Service eligibility, and the annual search for Outstanding BNS.
ontinuous service of the BNS. The inclusive period of service of the BNS as indicated
For the Outstanding BNS Award, the period of service is January to December of each
ay vary, as long as it covers a period of 2 years continuous satisfactory service.

task/activity of the BNS being evaluated. Give corresponding scores to each


column "Actual Score". Fill up the column "Remarks" when necessary to explain score

Remarks

3 March 2003, all children aged 0-71 months (at least 17.5% of total population) should

nd NCR areas, the following scoring system could be used for 1.A c:

. In cases where there are too many infants, the local nutrition committee could prescribe
ed monthly, but the number of infants should not be less than 200.
Remarks

y regardless of nutritional status (based on DOH-Administrative Order 25 Series 2003).


n infant feeding, meal management, wise buying, etc., and demonstrations on proper utilization of

er to the mother and child/children. If the family is visited twice, thrice or even 12 times

Remarks

Remarks

ion, senior citizens, Red Cross, Rotary Club), religious and school (i.e. Girl Scouts) that

e evaluation year should be supported by certificates of attendance.

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