Division Order/ Memorandum/Advisory: Division of City of San Fernando

Document Code:
Republic of the Philippines SDO-CSFP-QF-OSDS-004

Department of Education – Region III Central Luzon
Revision: 00
DIVISION OF CITY OF SAN FERNANDO
Effectivity Date: 04-12-2019
DIVISION ORDER/ Name of Office:

MEMORANDUM/ADVISORY OFFICE OF THE SCHOOLS
DIVISION SUPERINTENDENT
DIVISION MEMORANDUM
No. ___201__, s. 2020
July 28, 2020
TO : Assistant Schools Division Superintendent
All Heads and Personnel of Public Schools
FROM : OFFICE OF THE SCHOOLS DIVISION SUPERINTENDENT

SUBJECT : The Conduct of Medical Assessment for COVID-19 of Skeleton Work Force in
Schools
DATE : July 27, 2020
1. Pursuant to the safety precautions and protocols stated in DepEd Order No. 14, s. 2020,
Guidelines on the Required Health Standards in Basic Education Offices and Schools, this Office
reiterates to all concerned individuals to adhere to the protocols on the conduct of Medical
Assessment for COVID-19 of identified personnel on skeleton work force in schools.
2. School Heads are advised to submit a soft copy of the list of all school personnel qualified under
skeleton work force based from the exemptions listed in Enclosure No. 2 of this memorandum to
hnusgodcsfp@gmail.com on or before July 31, 2020.
3. The list to be submitted must contain the following data:
Name Position School Birthday Age Employee No.
4. This memorandum provides the guidelines in the following enclosures:
Enclosure No. 1 – StaySafe.PH account set up

Enclosure No. 2 – Individuals Exempted from Skeleton Work Force and Forms Needed
Enclosure No.3 – Schedule and Conduct of Health Assessment for COVID-19
(Initial and Re-assessment)
Enclosure No. 4 – Assessment Process Flow and Floor Plan
5. For wide dissemination and proper guidance of all concerned.
IMELDA P. MACASPAC, Ph.D.

Assistant Schools Division Superintendent
Officer-in-Charge
Office of the Schools Division Superintendent
Control No.: SGOD-DOMA-2020-_____
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Enclosure No. 1 – StaySafe.PH account set up
Pursuant to the safety precautions and protocols stated in DepEd Order No. 14, s. 2020, Guidelines on
the Required Health Standards in Basic Education Offices and Schools, all teaching and non-teaching
DepEd personnel are advised to download and set up a personal StaySafe.Ph account for monitoring.
How to download StaySafe.Ph App. (Mobile)

1. Go to Google Play (Android) or App Store (iOS)
2. Download the StaySafe.Ph App
3.
Register using your mobile number. (StaySafe follows the "Data Privacy Act")
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4. Complete the details on the setting
Note:
a. For Records purposes please
type in your full name
b. Your Home Address City/
Municipality
5. Answer and update your health status
Note: Please answer

truthfully and with all
honesty.
#SingleSourceOfTruth
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6. Show you QR code to the assigned health personnel during the TeleAssessment/ Online Assessment
7. Update your health status every 2 weeks during the teleassessment for renewal of the health pass
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Enclosure No. 2 – Individuals Exempted from Skeleton Work Force and Forms Needed
A. INDIVIDUALS EXEMPTED FROM SKELETON WORK FORCE
All identified personnel under Skeleton Work Force must undergo Medical Assessment at the Division
Training Conference Room 2 except the following:
1. Persons below 21 years old

2. 60 years old and above
3. Pregnant women
4. High risk/ Vulnerable individuals regardless of age
-Health-related concerns such as:
a. Hypertension
b. Diabetes
c. Chronic Kidney Disease
d. Asthma
e. Chronic Obstructive Pulmonary Disease
f. Cancer
g. Other immunodeficiencies, cardiac/pulmonary/metabolic concerns
B. FORMS NEEDED
Initial Assessment at the Division Training Conference Room 2
For the concerned personnel to be granted a health pass, the Division Office Administrative Personnel
must submit the following forms to the Business License and Permit Division (BLPD) at the City Hall:
1.List of Employees’ Names (Admin)

2.Medical Certificate (School Health Section)
3.Self-Assessment Form (COVID-19 Pagsusuri sa Sarili at the DTC2)
4. Certificate of Employment
Renewal via Teleassessment
For the concerned personnel to be granted a renewed health pass, the Division Office Administrative
Personnel must submit the following forms to the Business License and Permit Division (BLPD) personally
or via e-mail at csfp.blpd@gmail.com:
1.List of Employees’ Names

2.StaySafe.Ph Assessment
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Enclosure No.3 – Schedule and Conduct of Health Assessment for COVID-19

(Initial and Re-assessment)
All identified personnel under Skeleton Work Force must undergo Medical Assessment at the Division
Training Conference Room 2.
A. SCHEDULE FOR ASSESSMENT
Designation/Office Initial (Face-to-face) Renewal (Virtual - every 2

weeks)
Public School Personnel: Monday/Tuesday/Wednesday Monday/Tuesday/Wednesday
1. North District Monday (8-1PM) Monday (8-1PM)
2. East District Tuesday (8-1 PM) Tuesday (8-1PM)
3. West District Wednesday (8-1 PM) Wednesday (3-5 PM)
B. CONDUCT OF HEALTH ASSESSMENT FOR COVID – 19
Initial Assessment at the Division Training Conference Room 2
1.The concerned personnel may proceed to the Division Training Conference Room 2 following the
specified schedule.
2.Strict compliance to the Division Infection Prevention and Control Plan shall be implemented:
a. Physical/Social Distancing
b. Wearing of face mask at all times
c. Handwashing prior to and after assessment
3. Present Employee’s Identification Card for Validation (No I.D., No Assessment)
4. Conduct of Health Assessment using COVID-19 Pagsusuri sa Sarili (the City Health Office Issued Self
– Assessment Form)
All employees are expected to answer truthfully and with all honesty. #SingleSourceOfTruth
5.Personnel with Health Assessment Scores of zero to three (0-3) shall be cleared and issued a Medical
Certificate by the Medical Officer III or Dentist II.
6. Personnel with Health Assessment Scores of 4 and above (>4) shall be isolated and referred by the
COVID 19 Coordinator to the screening facility for proper management
7. The School Health Section shall submit the accomplished self-assessment forms and issued medical
certificates to the Admin-Personnel Section.
8. Admin-Personnel Section shall submit all the necessary forms to the Business License and Permit
Division (BLPD) for the certification and issuance of health pass
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Renewal via Teleassessment
1.Each Division Medical Personnel will be assigned with one (1) teleassessment account via doxy.me
2. One Division Medical Personnel shall cater to the teleassessment of Specific schools assigned to
him/her
3.School personnel will be provided with the specific link to the doxy.me account of the assigned medical
personnel.
4.The concerned personnel are encouraged to have two (2) smart devices (preferably 1 laptop and 1
smartphone) during the conduct of the teleassessment.
5. During the scheduled teleassessment, the concerned personnel must provide the following information:
a. Complete Name
b Employee ID No.
c.Age and sex
6. The concerned personnel shall log-in to his/her StaySafe.Ph account and update his/her health status
during the teleassessment.
All employees are expected to answer truthfully and with all honesty. #SingleSourceOfTruth
7. Once accomplished, the concerned personnel shall be instructed by the medical personnel to show the
QR code via the video call screen in order to immediately scan the results.
8. The Medical Personnel shall save the results via screencapture
9.Personnel with StaySafe.Ph Health Assessment of CLEARED shall be advised accordingly
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10. The Medical Personnel shall inform the COVID-19 Coordinator regarding concerned personnel with
StaySafe.Ph Health Assessment of NOT CLEARED and shall be referred by the COVID 19 Coordinator
to the screening facility for proper management
11 Once accomplished, the teleassessment window shall be closed and the medical personnel may
proceed to interview the next employee.
12. The School Health Section shall submit a soft copy of the consolidated screencaptured self-
assessment QR Code Results to the Admin-Personnel Section.
13. Admin-Personnel Section shall submit all the necessary forms to the Business License and Permit
Division (BLPD) for the certification and issuance of health pass via e-mail at csfp.blpd@gmail.com
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Enclosure No. 4 – Assessment Process Flow and Floor Plan

Pursuant to the safety precautions and protocols stated in DepEd Order No. 14, s. 2020, Guidelines on
the Required Health Standards in Basic Education Offices and Schools, all teaching and non-teaching
DepEd personnel are advised to comply with the minimum health standards released by DOH, DOLE and
CSC, as follows:
1. Maximum of 5 patients will be accommodated in the DTC Room 2
2. Physical/Social Distancing – 2meter (6feet) distance
3. Wearing of PPE materials and face mask at all times
4. Sanitize using alcohol prior to and after every assessment
5. Maintain privacy of each employee
6. Employees are expected to answer truthfully and with all honesty (#SingleSourceOfTruth)
A. ASSESSMENT PROCESS FLOW

The conduct of health assessment for COVID-19 process flow are as follows:
1. Nurse1 shall assist the employees for the instructions, directions, queries, and validation for the whole
duration of the assessment;
2. Nurse2 shall conduct the health assessment using the provided form and shall input the information in
the weekly health assessment consolidated form;
3. Medical Officer (M) and Dentist (D) shall conduct the validation and issuance of the Medical/ Workers
Certificate.
4. Personnel may leave the DTC2 when they are already cleared.
5. Personnel with identified influenza-like symptoms during the conduct of medical assessment shall be
subjected to mandatory rapid testing by the Medical Personnel.
6. Personnel who did not pass the assessment shall be referred by the COVID-19 coordinator to the
screening facility for proper management.
B. FLOOR PLAN SGOD BLDG. 2nd Floor DIVISION TRAINING CONFERENCE Room 2(DTC2)
STAIRS
STAIRS
Waiting
Area
UP DOWN
Registration DTC 2
Area
N1
DTC 3
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Division Order/ Memorandum/Advisory: Division of City of San Fernando

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Division Order/ Memorandum/Advisory: Division of City of San Fernando

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Document Code:

Republic of the Philippines SDO-CSFP-QF-OSDS-004

DIVISION ORDER/ Name of Office:

FROM : OFFICE OF THE SCHOOLS DIVISION SUPERINTENDENT

3. The list to be submitted must contain the following data:

Name Position School Birthday Age Employee No.

4. This memorandum provides the guidelines in the following enclosures:

Enclosure No. 1 – StaySafe.PH account set up

5. For wide dissemination and proper guidance of all concerned.

IMELDA P. MACASPAC, Ph.D.

Control No.: SGOD-DOMA-2020-_____

DIVISION ORDER/ Name of Office:

Enclosure No. 1 – StaySafe.PH account set up

How to download StaySafe.Ph App. (Mobile)

Control No.: SGOD-DOMA-2020-_____

DIVISION ORDER/ Name of Office:

4. Complete the details on the setting

5. Answer and update your health status

Note: Please answer

Control No.: SGOD-DOMA-2020-_____

DIVISION ORDER/ Name of Office:

Control No.: SGOD-DOMA-2020-_____

DIVISION ORDER/ Name of Office:

A. INDIVIDUALS EXEMPTED FROM SKELETON WORK FORCE

1. Persons below 21 years old

Initial Assessment at the Division Training Conference Room 2

1.List of Employees’ Names (Admin)

Renewal via Teleassessment

1.List of Employees’ Names

Control No.: SGOD-DOMA-2020-_____

DIVISION ORDER/ Name of Office:

Enclosure No.3 – Schedule and Conduct of Health Assessment for COVID-19

A. SCHEDULE FOR ASSESSMENT

Designation/Office Initial (Face-to-face) Renewal (Virtual - every 2

B. CONDUCT OF HEALTH ASSESSMENT FOR COVID – 19

Initial Assessment at the Division Training Conference Room 2

Control No.: SGOD-DOMA-2020-_____

DIVISION ORDER/ Name of Office:

Renewal via Teleassessment

8. The Medical Personnel shall save the results via screencapture

9.Personnel with StaySafe.Ph Health Assessment of CLEARED shall be advised accordingly

Control No.: SGOD-DOMA-2020-_____

DIVISION ORDER/ Name of Office:

Control No.: SGOD-DOMA-2020-_____

DIVISION ORDER/ Name of Office:

Enclosure No. 4 – Assessment Process Flow and Floor Plan

A. ASSESSMENT PROCESS FLOW

Control No.: SGOD-DOMA-2020-_____

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