RESULTS

(WEIGHMENT METHOD)
(Nutrient wise)
Name of the Investigator ______________________ Place ______________________ Family No._________________________

Head of Family ________________________ Household Ho _________________ Total ACU _________________________

Energy Protein Fat Carbo- Calcium Iron Vit A Vit B1 Vit B2 Nicotinic Vit C Free
(cal) (gm) (gm) hydrate (mg) (mg) (mg) (mg) (mg) Acid (mg) Folic
(gm) (mg) Acid
(mg)
REQUIREMENT Total

Per A.C.U

CONSUMPTION Total

Per A.C.U

DEFICIENCY Total

Per A.C.U

Percentage

EXCESS Total

Per A.C.U

Percentage

(Signature of Investigator)
 RESULTS
(WEIGHMENT METHOD)
(Food group wise)
Name of the Investigator ______________________ Place ______________________ Family No._________________________

Head of Family ________________________ Household Ho _________________ Total ACU _________________________

Cereal Pulses Roots & Leafy Other Fat & Milk & Flesh Sugar & Fruits
(gm) (gm) Tubers Veg. Veg. Oil Milk Foods Jaggery &
(gm) (gm) (gm) (gm) Product (gm) (gm) Nuts.
(gm) (gm)
REQUIREMENT Total

Per A.C.U

CONSUMPTION Total

Per A.C.U

DEFICIENCY Total

Per A.C.U

Percentage

EXCESS Total

Per A.C.U

Percentage

(Signature of Investigator)