Republic of the Philippines

Province of Cavite
NUTRITION OFFICE
Municipality of Maragondon
Maragondon Cavite

Observation/Evaluation Checklist Field Practicum

Role and Functions of BNS

Name of Barangay Nutrition Scholar: _______________________ Barangay: __________________

Criteria Yes No Remark

Planning (1/3 MOV-BNC minutes of meeting, drafted BNAP)
1. Assisted the barangay chairperson to organize or reactivate the BNC
2. Initiated and assisted the BNC in the formulation of the BNAP
3. Formulated or drafted Barangay Nutrition Action Plan
Coordination (1/3 MOV- BNC minutes of meeting, accomplishment reports)
1. Initiated meetings of the BNC and submitted minutes of meeting
2. Facilitated nutrition-related meetings
3. Coordinated implementation of nutrition intervention activities
4. Referred clients to appropriate service providers
Advocacy (1/1 MOV- BNC minutes of meeting, accomplishment reports, BNSAP)
1. Promoted and advocated nutrition programs
Implementation (2/7 MOV- Accomplishment reports, BNSAP, photo documentation, masterlist of beneficiaries, BNS diary)
1. Counseled the mothers of children
2. Conducted annual weighing and measuring of all preschool children (OPT Plus)
3. Provided basic nutrition and health information to clients
4. Referred sick and malnourished children to health facilities
5. Referred eligible targets to feeding program, and/or environmental health programs
6. Provided basic nutrition and health services to clients (distribution of micronutrient
supplements, deworming tablet, seeds or seedlings, etc)
7. Conducted nutrition and health education classes to clients
Monitoring & Evaluation (2/4 MOV-Monthly weighing report, accomplishment report, BNS diary, monitoring report, masterlisting)
1. Monitored nutritional status (e.g. monthly monitoring of 0-23 months old PSC & 0-59
months old malnourished PSC)
2. Followed up clients of beneficiaries of nutrition activities
3. Monitored implementation of nutrition and nutrition-related laws, ordinances and
policies (e.g. monitoring of saktong iodine sa asin, food fortification, Sangkap Pinoy
Seal on sari sari stores, karinderia, markets, or households)
4. Provided feedback and updates to the BNC, C/MNAO and D/CNPC thru meeting
Resource Mobilization/ generation (MOV-BNAP, minutes of meeting)
1. Mobilized and generated human and financial resources in coordination with the
BNC
Documentation & Record Keeping (1/2 MOV- BNC minutes of meeting, accomplishment reports, masterlists of beneficiaries)
1. Prepared minutes or highlights of meeting, prepared brief write-ups and diaries, and
take photos of important activities
2. Ensured the preservation of data (e.g. BNAP, BNSAP, masterlist of beneficiaries,
accomplishment report, minutes of meeting, OPT Plus report, etc)

Accomplished by: _________________________________________ Date: _______________________

Nutrition Action Officer/ Nutrition Program Coordinator

Noted by: _______________________________________________________ Date: _______________________

Provincial Nutrition Action Officer/ District Nutrition Program Coordinator
 Republic of the Philippines
Province of Cavite
NUTRITION OFFICE
Municipality of Maragondon
Maragondon Cavite
Observation/Evaluation Checklist Field Practicum
Operation Timbang Plus

Name of Barangay Worker: _______________________ Barangay: __________________

Criteria Yes No Remark

Pre-Implementation
1. The masterlist of 0-59 months PSC is available
2. Supplies and measuring devices are readily available and prepared before the
activity
Implementation Phase
1. Conduct of Activity
a. Fixed Site
b. House to house
Interviewing Skills
1. Did the BNS or BHW greet the mother and introduce her/ himself?
2. Did the BNS or BHW explain the purpose of the activity?
3. Was the BNS or BHW able to generate complete information based on the family
profile form?
4. Tone in interviewing mother or caregiver was friendly
5. Birth certificate was used to validate child’s birthday
Actual Weighing
1. Adjustment screw is working and the needle or pointer moves freely
2. Weighing pants are clean and free from tear
3. Weighing scale was calibrated and adjusted accordingly
4. Weighing scale was adjusted to “0” with the weighing pants
5. Face dial of scale at eye level, not lower or higher
6. Child was barefoot
7. Child was not wearing heavy clothes
8. Child’s pocket was checked, heavy objects were removed
9. Child was put in weighing pants correctly
10. The strap of the weighing pants was in front of the child
11. One hand held the child while the other hand placed the weighing pants with the
child on the hook
12. The child was not holding on to anything when being weighed, and no one was
holding onto the child while he/she was being weighed
13. Reading of weight was done when needle was no longer moving
14. Child was removed from the weighing pants properly
Actual measurement
1. The measuring board is placed on a hard flat surface
2. No hair accessories
3. Child’s head is placed on against the base of the board when measuring length
4. The child’s line of vision is perpendicular to the ground
5. Child’s feet lies flat on the board
6. Measurer reads height/length on eye level

Accomplished by: _______________________________________

Nutrition Program Coordinator
 Republic of the Philippines
Province of Cavite
NUTRITION OFFICE
Municipality of Maragondon
Maragondon Cavite
Observation/Evaluation Checklist
Mass Deworming Activity

Municipality/City of _____________________________ Date ______________________

Name of Barangay Worker: _______________________ Barangay: __________________

Criteria Yes No Remark

Pre-Implementation
1. The masterlist of the target population is available
1.1 Pre School Age Children (1-4 years old)
1.2 School Aged Children (5-12 y.o.)
1.3 School Aged Children (13-18 y.o.)
2. Service Delivery Adverse Event following MDA Masterlist
3. Supplies are readily available and prepared before the activity
4. Health worker checks the expiration date of the supply before giving
Implementation Phase
1. Conduct of Activity
c. Fixed Site
d. House to house
Interviewing Skills
1. Did the BNS or BHW greet the mother and introduce her/ himself?
2. Did the BNS or BHW explain the purpose of the activity?
3. Was the BNS or BHW able to generate complete information based on the family
profile form?
4. Did the BNS or BHW thank the client after the interview?
Client Survey
1. The caregiver is aware of the importance/benefits of the program
2. The caregiver is aware of the implementation schedule of the program
3. Did the mother refused the program?

Accomplished by: _______________________________________

Nutrition Program Coordinator
 Republic of the Philippines
Province of Cavite
NUTRITION OFFICE
Municipality of Maragondon
Maragondon Cavite
Monitoring Checklist
Municipality/City of _____________________________ Date _____________________________________
Barangay: ___________________________________ Population: ________________________________
Name of Barangay Worker: ______________________

A. OPERATION TIMBANG PLUS (OPT +)

Target % Remarks/Observation on weight and height
# of PSC Weighed
0-59 months PSC Coverage measurement:

B. Soil Transmitted Helminthiasis Control Program (STHCP)

1-4 years old 5-12 years old Children 13-18 years old Children
Target
# of PSC
Target
# of children
Target
# of children Remarks/Observation:
Dewormed Dewormed dewormed

C. Nutrition Indicators
Vitamin A Supplementation IYCF MNP

# of 6-11 months
PSC given MNP
# of 0-6 months
12 – 59 months

complementary
# of 12-59 mos

# of 12-59 mos
6 – 11 months

PSC recorded
# of 6-11 mos

months PSC
(100,000 IU)

reported as
# of Infants

Exclusively
200,000 IU

200,000 IU

# of infants

given MNP
# of 12-59
breastfed
TARGET

TARGET

(Doze 1)

(Doze 2)
given

given

given
PSC

PSC

fed

Remarks/Observation:

D. Inventory of Supplies
Others (please
Powder (MNP)

Ferrous Drops

RUTF/ RUSF
(100, 000 IU)

(200, 000 IU)

Micronutrient

Rehydration

Zinc Sulfate
Sulfate with
Deworming

Carbonate
Folic Acid
Vitamin A

Vitamin A

Calcium

Solution
Ferrous

specify)
Tablet

Oral

Balance
Expiration
Date
Weight Height
 Hanging Type __________
 Height/length board _________
 Beam Balance _________
 Steel ruler _________
Measuring Tool  Bathroom scale _________
 Others; please specify _______
 Others; please specify _______
 None
 None
MUAC Tape ____________________

Monitoring Checklist
 Republic of the Philippines
Province of Cavite
NUTRITION OFFICE
Municipality of Maragondon
Maragondon Cavite

Municipality/City of _____________________________ Date _____________________________________

Barangay: ___________________________________ Population: ________________________________
Name of Barangay Worker: ______________________

A. OPERATION TIMBANG PLUS (OPT +)

Target % Remarks/Observation on weight and height
# of PSC Weighed
0-59 months PSC Coverage measurement:

B. Soil Transmitted Helminthiasis Control Program (STHCP)

1-4 years old 5-12 years old Children 13-18 years old Children
Target
# of PSC
Target
# of children
Target
# of children Remarks/Observation:
Dewormed Dewormed dewormed

C. Inventory of Supplies

Others (please
Powder (MNP)

Ferrous Drops

RUTF/ RUSF
(100, 000 IU)

(200, 000 IU)

Micronutrient

Rehydration

Zinc Sulfate
Sulfate with
Deworming

Carbonate
Folic Acid
Vitamin A

Vitamin A

Calcium

Solution
Ferrous

specify)
Tablet

Oral

Balance
Expiration
Date
Remarks/Observation:

Weight Height
 Hanging Type __________
 Height/length board _________
 Beam Balance _________
D. Measuring  Steel ruler _________
 Bathroom scale _________
Tool  Others; please specify _______
 Others; please specify _______
 None
 None
MUAC Tape ____________________
Remarks/Observation:

Accomplished by: _______________________________________

Nutrition Program Coordinator

Attested by: _______________________________________

Local Nutrition Coordinator