Department of Education

Region VII, Central Visayas

Division of Cebu
DISTRICT OF_____________________
MONITORING CHECKLIST OF SCHOOL CHILDREN HANDWASHING ACTIVITIES
(Essential Health Care Program)
SY 20____-20_____
NAME OF SCHOOL________________________________TEACHER:__________________________GRADE/SECTION:__________MONTH OF:_______________20____
DAILY CHECKLIST OF HANDWASHING TOTAL NUMBER
NAME OF PUPILS Handwash Not Washing

PREPARED BY: NOTED:

___________________________________ _______________________________
Adviser School Head
 TOOTHBBRUSHING DRILL CHECKLIST
MONTH OF_________________________
SY________________________
School:__________________________________
Grade & Section:__________________________
Date 1 2 3 4 5 6 7 8 9 1 1 12 1 14 1 1 17 1 19 2 21 2 2 24 2 26 2 2 29 3 31
0 1 3 5 6 8 0 2 3 5 7 8 0
Toothbrush Holders
Toothbrushes
NAME

Legend: () check mark for tooth brushing Encircle Saturday, Sunday & Holiday with red ball pen Noted: Prepared by:
( a ) For absent __________________________ __________________________
( x ) present but not brushing School Head Class Adviser