8. DO No. 10, s. 2021
SBFP Form ANNEX E
(PARENT’S CONSENT FOR MILK FEEDING)
9. DO No. 10, s. 2021
SBFP Form 6
REGION/DIVISION/DISTRICT: ______________________________________________________________________________
NAME OF SCHOOL: ______________________________________________________________________________
SCHOOL ID NO.: ______________________________________________________________________________
New Replacemen
t
Total (New +
Replacement
)
Kinder
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
TOTAL:
New Replacemen
t
Total (New +
Replacement
Kinder
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
TOTAL:
Prepared by: APPROVED BY:
School Feeding Coordinator School Head
No. of Packs for
Replacement/
Rejected
Remarks
MILK DELIVERIES (SY________)
Grade Level Number of Beneficiaries Date
Delivered
No. of Packs Received
DEPARTMENT OF EDUCATION
Region ___X
SCHOOL-BASED FEEDING PROGRAM
NFP DELIVERIES (SY 2021 -2022
Number of Beneficiaries Date
Delivered
No. of Packs Received No. of Packs for
Replacement/
Rejected
Remarks
Grade Level
10. DO No. 10, s. 2021
SBFP PTR FORM A
Document Code:
Revision:
Ef f ect ivit y dat e: 01
-01
-2021
BLSS-School Health Division
Period Covered:
A. ACCOMPLISHMENTS
1. SBFP Coverage: Primary Beneficiaries for Nutritious Food Products
2. SBFP Coverage: Secondary Beneficiaries for Nutritious Food Products
0
0
0 0 0 0 0
0
0
0
0
0 0 0 0
Stunted
Pupils-at-Risk-of-
Dropping-Out
(PARDOs)
Indigenous Peoples Indigent Learners TOTAL
Wasted TOTAL
0
0
SPED
Grade 6 0
0
Multigrade
Grade Level
Kinder
Grade 1
Grade 2
Grade 3
Grade 4
School Address:
Total No. of T & NTP:
Total Enrolment:
TOTAL
Grade 5
Grade 6
SPED
Multigrade
TOTAL
0
0
0
0
Grade 5
Grade 4 0
0
Grade 3
Grade 2 0
0
Grade 1
Kinder
Quality Form
OK sa DepEd - School-Based Feeding Program (SBFP)
Program Terminal Report Form
(SBFP PTR - Form A)
Fax Number: Email Address:
Region/Division:
School Name & ID:
School Telephone Number: Mobile Number:
Grade Level All Kinder Severely Wasted
11. DO No. 10, s. 2021
SBFP PTR FORM A
3. SBFP Coverage: Primary Beneficiaries for Milk
4. SBFP Coverage: Secondary Beneficiaries for Milk
SPED 0
Multigrade 0
Grade 6 0
TOTAL 0 0 0 0 0
Grade 4 0
Grade 5 0
Grade 2 0
Grade 3 0
Kinder 0
Grade 1 0
TOTAL 0 0 0 0
Grade Level Stunted
Pupils-at-Risk-of-
Dropping-Out
(PARDOs)
Indigenous Peoples Indigent Learners TOTAL
SPED 0
Multigrade 0
Grade 5 0
Grade 6 0
Grade 3 0
Grade 4 0
Grade 1 0
Grade 2 0
Grade Level All Kinder Severely Wasted Wasted TOTAL
Kinder 0
12. DO No. 10, s. 2021
SBFP PTR FORM A
5. Type of Food Commodities Distributed to Learners (Check applicable items)
a. Nutritious Food Products
b. Milk
6. SBFP Funds (for those with downloaded funds)
Rootcrops
Fruits
Vegetables
Nutripacks
Fresh Milk
Sterilized Milk
Commercial Milk
Provided by Partner
Enutribun
Fortified/Enriched Bread
Tranches Amount Received from SDO
Total:
Percent Utilization
(col 3/2*100%)
Funds Utilized
13. DO No. 10, s. 2021
SBFP PTR FORM A
B. DONATIONS/ RESOURCES GENERATED
(Add Additional Sheets, if needed)
C.
(Add Additional Sheets, if needed)
SIGNIFICANT EVENTS OF SBFP, AND OTHER HEALTH AND NUTRITION PROGRAMS/
EXPERIENCES/ GOOD PRACTICES
What happened? Who were involved? When Outcome: What is/are its important contribution to
the School-Based Feeding Program of the school?
Partner & Type of Donations/Services Provided Quantity (if applicable) Estimated Cost (if applicable)
14. DO No. 10, s. 2021
SBFP PTR FORM A
F. PHOTOS (Before, During and After)
Date:
SBFP Coordinator School Head
E. PROPOSED PLAN OF ACTION AND RECOMMENDATIONS
Prepared by: Noted:
D. LESSONS LEARNED G. SUGGESTIONS TO STRENGTHEN SBFP (Include
support needed from Central, Region, and Division Office that can
increase the impact of OK sa DepEd Program in the schools)
15. DO No. 10, s. 2021
Requisition and Issue Slip
Entity Name: Fund Cluster:
Division: Masbate Responsibility Center Code:
Office: RIS No.
Stocks No. Unit Quantity YES NO Quantity
Description Remarks
Appendix 63
REQUISITION AND ISSUE SLIP
REQUISITION Stock Available? ISSUANCE
Purpose:
Issued by:
Signature:
Printed Name:
Designation:
Date:
Requested by: Approved by: Received by:
16. DO No. 10, s. 2021
Requisition and Issue Slip
FOR DISTRICT LEVEL:
REQUESTED BY: THE PSDS
APPROVED BY: MARIA THERESA A. BASAS (SUPPLY)
ISSUED BY: (PLEASE LEAVE IT BLANK)
RECEIVED BY: DISTRICT PROPERTY CUSTODIAN
*( the signatories in the supplier’s official receipt should be the same in the RIS )
17. DO No. 10, s. 2021
Requisition and Issue Slip
FOR SCHOOL LEVEL:
REQUESTED BY: THE PRINCIPAL/SCHOOL HEAD
APPROVED BY: THE PSDS
ISSUED BY: DISTRICT PROPERTY CUSTODIAN
RECEIVED BY: SCHOOL PROPERTY CUSTODIAN
18. DO No. 10, s. 2021
Inspection and Acceptance Report
Entity Name : DEPARTMENT OF EDUCATION, DIVIISON OF MASBATE Fund Clus te r :
Supplier : IAR No. :
PO No./Date : Date :
Requisitioning Office/Dept. : Invoice No. :
Responsibility Center Code : Date :
Appendix 62
INSPECTION AND ACCEPTANCE REPORT
Stock/
Property No.
Description Unit Quantity
INSPECTION ACCEPTANCE
Date Ins pe cte d : ________________________ Date Re ce ive d : _____________________
Inspected, verified and found in order as to quantity
and specifications
Com
plete
Partial (pls. specify quantity)
School Inspection Committee
Inspection Officer/Inspection Com
mittee District and/or School Property Custodi
an
19. DO No. 10, s. 2021
Inspection and Acceptance Report
FOR DISTRICT LEVEL:
INSPECTED BY: THE DISTRICT INSPECTORATE TEAM
ACCEPTED BY: THE DISTRICT PROPERTY CUSTODIAN
FOR SCHOOL LEVEL:
INSPECTED BY: THE SCHOOL INSPECTORATE TEAM
ACCEPTED BY: THE SCHOOL PROPERTY CUSTODIAN
21. DO No. 10, s. 2021
SUBMISSION OF RIS & IAR & OTHER DOCUMENTS
PLEASE PREPARE 3 COPIES EACH (RIS & IAR)
ALL 3 COPIES SHOULD BE ORIGINAL
1 COPY OF DISTRICT LIST OF AUTHORIZED CONSIGNEE &
DISTRICT INSPECTION TEAM
DOCUMENTS SHOULD BE ARRANGED BY SET:
1 set for ACCOUNTING SHOULD CONTAIN (1 RIS, 1 IAR,
PICTURES, 1 DISTRICT SUMMARY OF DISTRIBUTION LIST)
1 set for SUPPLY OFFICE ( 1 RIS, 1 IAR, 1 DISTRICT SUMMARY
OF DISTRIBUTION LIST)
1 set for SCHOOL HEALTH SECTION OFFICE (1 RIS, 1 IAR,
PICTURES, 1 DISTRICT SUMMARY OF DISTRIBUTION LIST)
1 WEEK AFTER DELIVERY ALL DOCUMENTS SHOULD BE
SUBMITTED @ SCHOOL HEALTH SECTION OFFICE
22. DO No. 10, s. 2021
SUBMISSION OF RIS & IAR & OTHER DOCUMENTS
ALL SCHOOL SHOULD PREPARE THE FOLLOWING FORMS TO BE
SUBMITTED BEFORE START OF IMPLEMENTATION
1. FORM 1 (LIST OF BENEFICIARIES)
2. FORM 2 (SUMMARY OF BENEFICIARIES) START OF FEEDING
3. FORM 4 (LIST OF AUTHORIZED CONSIGNEE/INSPECTION TEAM)
4. FORM 5 (LIST OF BENEFICIARIES FOR MILK FEEDING)
5. BASELINE NUTRITIONAL STATUS REPORT
REPORT TO BE SUBMITTED AFTER/END OF PROGRAM IMPLEMENTATION
1. OK SA DEPED SBFP PROGRAM TERMINAL REPORT FOR SCHOOL LEVEL
2. FORM 6 NFP & MILK DELIVERIES
3. FORM 2 (SUMMARY OF BENEFICIARIES) END OF FEEDING
4. ENDLINE NUTRITIONAL STATUS REPORT
THE SBFP DISTRICT COORDINATOR SHALL SUBMIT THE CONSOLIDATED
TERMINAL REPORT USING THE OK SA DEPED PROGRAM TERMINAL
REPORT FORM FOR DISTRICT LEVEL
24. DO No. 10, s. 2021
SBFP NFP/MILK RECEIVING SHEET AT SCHOOL
25. DO No. 10, s. 2021
SBFP NFP/MILK INCIDENT REPORT FORM
26. Commodities will be distributed to the beneficiaries AT
SCHOOL DAILY ACCORDING TO THE PRESCRIBED
SCHEDULED MENU.
* Nutribun ( carrot/squash )
* Kamote at Buto ng Kalabasa Nutribar to be consumed by
* Rice Mongo Curls beneficiaries AT SCHOOL
* Malunggay Nutri Galletas during RECESS TIME
* Squash Nutri Sticks
* Malunggay Choco Oat Crinkles
* Powdered Milk /
sterilized milk/ fresh milk
METHOD OF DISTRIBUTION
27. Commodities will be distributed to the beneficiaries AT
SCHOOL DAILY ACCORDING TO THE PRESCRIBED
SCHEDULED MENU.
* Iron Fortified Rice to be consumed by
* Monggo beneficiaries AT HOME.
METHOD OF DISTRIBUTION
28. FIRST BATCH
( START OF FEEDING: OCTOBER 2, 2023)
1. CLAVERIA NORTH 9. AROROY EAST
2. CLAVERIA SOUTH 10. AROROY WEST
3. SAN PASCUAL NORTH 11. BALENO
4. SAN PASCUAL SOUTH 12. MANDAON NORTH
5. BATUAN 13. MANDAON SOUTH
6. MONREAL
7. SAN FERNANDO
8. SAN JACINTO
IMPLEMENTATION OF SBFP-
MILK PER BATCH
29. SECOND BATCH
( START OF FEEDING: OCTOBER 9, 2023)
1. BALUD NORTH 9. DIMASALANG 17. PLACER EAST
2. BALUD SOUTH 10. PALANAS SOUTH 18. PLACER WEST
3. MILAGROS EAST 11. PALANAS NORTH 19. ESPERANZA
4. MILAGROS WEST 12. USON NORTH 20. AROROY EAST
5. MOBO NORTH 13. USON SOUTH 21. AROROY WEST
6. MOBO SOUTH 14. CAWAYAN EAST 22. BALENO
7. CATAINGAN EAST 15. CAWAYAN WEST 23. MANDAON NORTH
8. CATAINGAN WEST 16. PIO V. CORPUS 24. MANDAON SOUTH
IMPLEMENTATION OF SBFP-
NFP/MILK PER BATCH
