Republic of the Philippines

Department of Health
NATIONAL NUTRITION COUNCIL

OPT Form 1. List of Preschoolers Weighed and Nutritional Status

Barangay______________________________ City/Municipality ___________________________ Province _______________ Year ___________

Household Name of Household Head/ Name of Preschoolers Weighed Sex Date of Birth Date of Age in Weight Nutrit ional PS w/ Cleft
Nu mber Mother/Caregiver (Yr-Mo-Day) Weighing Months 1/ in kgs Status* Palate or Harelip
(3) (Yr-Mo-Day) (weight for Age)
(1) (2) (4) (5) (6) (7) (8) (9) (10)

*Codes for Nutritional Status: Weight-for-age: N-Normal UW-Unde rweight SEV-Severely Underweight OW- Ove rweight
1/ Age- in-Months, always refers to completed member of months, i.e. 34 months and 30 days is considered 34 months only

Prepared By: ________________________________________ Date:____________________________________

Barangay Nutrition Scholars
 Republic of the Philippines
Department of Health
NATIONAL NUT RITION COUNCIL

OPT Form 1A. Barangay Tally and Summary Sheet of Preschoolers weighed by Age Group, Sex and Weight Status
Barangay ____________________________ Estimated No. of Preschoolers 0-71 months old ______________________ Year __________
City/Municipality _____________________ Actual No. of Preschoolers weighed 0-71 months old _______________
Province ____________________________ Percent OPT Coverage ____________________________

Age Weight Status Total Number of PS

Grouping Weighed by Sex
(1) Normal Underweight Severely Underweight Overweight
Boys Girls Total Boys Girls Total Boys Girls Total Boys Girls Total Boys Gils Total
(2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) (20) (21) (22) (23)
0-5
Months
(R1)
6-11
Months
(R2)
12-23
months
(R3)
24-35
Months
(R4)
36-47
Months
(R5)
48-59
months
(R6)
60-71
months
(R7)
Total
(R7)
Percentage
(R8)
Note: R1 means Row 1, R2 means Row 2, etc.

Prepared By: ______________________________________ Approved by: __________________________________________________ Date:_________________________

Barangay Nutrition Scholars Chairperson, Barangay Nutrition Committe
 Republic of the Philippines
Department of Health
NATIONAL NUTRITION COUNCIL

OPT Form 1B. List of Priority Preschoolers 0-71 Months old

Page 1 of 3

Barangay_______________________ Province_____________________
City/Municipality_________________ Year _______________________

Household Name of household Head/ Name of Preschooler Sex Age in Months

Number Mother/Caregiver
Underweight
(1) (2) (3) (4) (5)

Prepared by ________________________ Date_______________

Barangay Nutrition Scholar

Approved by _____________________________________ Date_______________

Chairperson, Barangay Nutrition Committee
 Republic of the Philippines
Department of Health
NATIONAL NUTRITION COUNCIL

OPT Form 1B. List of Priority Preschoolers 0-71 Months old

Page 1 of 3

Barangay_______________________ Province_____________________
City/Municipality_________________ Year _______________________

Household Name of household Head/ Name of Preschooler Sex Age in Months

Number Mother/Caregiver
Severely Underweight
(1) (2) (3) (4) (5)

Prepared by ________________________ Date_______________

Barangay Nutrition Scholar

Approved by _____________________________________ Date_______________

Chairperson, Barangay Nutrition Committee
 Republic of the Philippines
Department of Health
NATIONAL NUTRITION COUNCIL

OPT Form 1B. List of Priority Preschoolers 0-71 Months old

Page 1 of 3

Barangay_______________________ Province_____________________
City/Municipality_________________ Year _______________________

Household Name of household Head/ Name of Preschooler Sex Age in Months

Number Mother/Caregiver
Overweight
(1) (2) (3) (4) (5)

Prepared by ________________________ Date_______________

Barangay Nutrition Scholar

Approved by _____________________________________ Date_______________

Chairperson, Barangay Nutrition Committee
BNS Form No. 3A

MONTHLY RECORD OF WEIGHT AND WEIGHT ST ATUS

0-23 MONTHS

Province: City/Municipality Barangay:

DATE OF WEIGHING
January February March April May June
Name of Child Date of Birth Age in Weight Weight Age in Weight Weight Age in Weight Weight Age in Weight Weight Age in Weight Weight Age in Weight Weight
(Y/M/D) Months Kg. Status Months Kg. Status Months Kg. Status Months Kg. Status Months Kg. Status Months Kg. Status

Summary (to be accomplished Monthly)

Number Identified
Number of SEV UW
Number of UW
Number of Normal
Number of OW
Number I mproved in Nutritional Status
Number Dead
Number Moved Out

Dated Validated: ___________________________________

Validated by: _____________________________________

NAO/D/CNPC
BNS Form No. 3A

MONTHLY RECORD OF WEIGHT AND WEIGHT ST ATUS

0-23 MONTHS

Province: City/Municipality Barangay:

DATE OF WEIGHING
July August September October November December
Name of Child Date of Birth Age in Weight Weight Age in Weight Weight Age in Weight Weight Age in Weight Weight Age in Weight Weight Age in Weight Weight
(Y/M/D) Months Kg. Status Months Kg. Status Months Kg. Status Months Kg. Status Months Kg. Status Months Kg. Status

Summary (to be accomplished Monthly)

Number Identified
Number of SEV UW
Number of UW
Number of Normal
Number of OW
Number I mproved in Nutritional Status
Number Dead
Number Moved Out

Dated Validated: ___________________________________

Validated by: _____________________________________

NAO/D/CNPC
BNS Form No. 3B

SEMEST RAL RECORD OF WEIGHT AND WEIGHT ST ATUS

24-71 MONT HS

Province: City/Municipality Barangay:

DATE OF WEIGHING
January - June July - December
Name of Child Date of Birth (Y/M/D) Age in Months Weight Weight Status Age in Months Weight Weight Status
Kg. Kg.

Summary (to be accomplished Monthly)

Number Identified
Number of SEV UW
Number of UW
Number of Normal
Number of OW
Number I mproved in Nutritional Status
Number Dead
Number Moved Out

Dated Validated: ___________________________________

Validated by: _____________________________________

NAO/D/CNPC
BNS Form No. 3C

MONTHLY RECORD OF WEIGHT AND WEIGHT ST ATUS

SEVERELYUNDERWEIGHT (SEV UW) / UNDERWEIGHT (UW) (0 -71)

Province: City/Municipality Barangay:

DATE OF WEIGHING
January February March April May June
Name of Child Date of Birth Age in Weight Weight Age in Weight Weight Age in Weight Weight Age in Weight Weight Age in Weight Weight Age in Weight Weight
(Y/M/D) Months Kg. Status Months Kg. Status Months Kg. Status Months Kg. Status Months Kg. Status Months Kg. Status

Summary (to be accomplished Monthly)

Number Identified
Number Improved in Nutritional Status
Number Dead
Number Moved Out

Dated Validated: ___________________________________

Validated by: _____________________________________

NAO/D/CNPC
BNS Form No. 3C

MONTHLY RECORD OF WEIGHT AND WEIGHT ST ATUS

SEVERELYUNDERWEIGHT (SEV UW) / UNDERWEIGHT (UW) (0 -71)

Province: City/Municipality Barangay:

DATE OF WEIGHING
July August September October November December
Name of Child Date of Birth Age in Weight Weight Age in Weight Weight Age in Weight Weight Age in Weight Weight Age in Weight Weight Age in Weight Weight
(Y/M/D) Months Kg. Status Months Kg. Status Months Kg. Status Months Kg. Status Months Kg. Status Months Kg. Status

Summary (to be accomplished Monthly)

Number Identified
Number Improved in Weight
Number Dead
Number Moved Out

Dated Validated: ___________________________________

Validated by: _____________________________________

NAO/D/CNPC