Child Details

BASELINE (ENROLMENT) AND MONITORING (FOLLOW-ON) CHILD VULNERABILITY STATUS	Time of Application
	1

Date of enrollment: 19 Mar, 2014 Name of Child: Chris Name of Caretaker: Emilie Current Residence Kampala, Uganda

OVC ID Number: UG016 Sex of Child: Male Sex of Caretaker: Female Parish: Mpererwe

Date of Birth: 1 May, 2010 Age of Caregiver: 54 years HouseHold No: TOP/007/NAMUNGOONA Vulnerability Type: None

1.0 ECONOMIC STRENGTHENING

1.1 Child is an income earner (Indicate Yes/No)

No

1.2 Child has vocational /apprenticeship skills (indicate Yes/No/NA Skip if is enrolled in formal school or below 12 years)

No

1.3 Child who completed vocational/ apprenticeship training has startup kit (indicate Yes/No/NA Skip if child is enrolled in school or below 12 years)

No

2.1 How many meals does the child eat in a day? (tick appropriate option)    { C }
a. Three or more meals a day	b. Two meals a day	c. One meal a day	d. Some days, child has no meal

2.2 Child is fed on a balanced diet regularly (indicate Yes/No and tick the appropriate option A to C and indicate score on appropriate column for time of application)     { NO }
Energy foods; potatoes, banana, oils, posho, millet, rice, maize, bread, cassava	Body building foods; beans, meat, soya, peas, milk, eggs, chicken, fish	Protective and regulative foods; tomatoes, oranges, pawpaw, mangoes, pineapples

Answers
a. Eats only one category	b. Eats at least two categories	c. Eats all categories/ breast feeding

3.0 HEALTH, WATER, SANITATION AND SHELTER

The following conditions apply to the child (indicate Yes/No/NA)

3.1 Does not sleep under insecticide treated (mosquito) bed net

Yes

3.2 Frequently sick with minimal access to health care

No

3.3 If child is chronically ill (HIV+), child has enrolled on ART (care and treatment)

No

3.4 Has not received required immunization for appropriate age (0-5 years only- check for immunization card)

No

4.0 EDUCATION

4.1 Child (5-17 years) is regularly attending school (tick appropriate option and indicate on appropriate column for time of application)
a. Never been to school	b. Dropped out of school	c. Child irregularly attends school	d. Child regularly attends school

4.2 Child has needed scholastic materials (Yes/No/ skip if child is below schooling going age, dropped out of school /or never been to school)

No

4.3 Child is progressing well in school (Yes/No/NA. Skip if child is below schooling going age, dropped out of school /or never been to school)

No

5.0 PSYCHOSOCIAL SUPPORT AND BASIC CARE

5.1 Child has essential/basic requirements (Tick appropriate options)
a. Owns at least a pair of shoes	b. Has at least 2 sets of clothing (Excluding school uniform)	c. Has bedding (raised bed, mattress, blanket)

5.2 Within the last one month, child has often felt hopeless, sad, worried, stressed, withdrawn, depressed (Yes/No)

No

5.3 Child has at least one adult who provides consistent care, attention and support (Yes/No)

No

6.0 CHILD PROTECTION AND LEGAL SUPPORT

The following conditions apply to the child (indicate Yes/No)

6.1 Child physically abused within the last 3 months

No

6.2 Withheld a meal to punish within the last 3 months

No

6.3 Child separated from family (ran away, chased)

No

6.4 Child felt neglected within the last 3 months

No

6.5 Sexually abused, defiled, shown pornography, raped, forced sex within the last 12 months

No

6.6 Involved in child labour

No