ANNEX E: COVID-19 MONITORING TOOLS

Tool Description
Para sa mga Magulang For distribution to parents of learners who will report to school; may be part of the parent's consent that they will sign in approving
learner's physical reporting to school

Notice to Reporting Personnel For display at the entrance gate and/or for distribution to reporting personnel (may be signed at least once)

Visitor's Declaration Form For visitors who will enter the school; to be accomplished by the visitor and assessed properly by designated school staff prior to
approval of entry (there must be guidelines as to when visitors may be accommodated and
for what identified purposes)

Teacher's Record For teachers to keep per class, each day, during health routine inspection (teacher may be provided with step-by step instruction on how to
facilitate the inspection using the tool)

Logsheet For safekeeping at the Clinic c/o the Clinic Teacher/Nurse to record all cases managed at the Clinic

School Head's Summary The school head shall keep a summary of the health status of learners and personnel, especially those who will manifest COVID-19
symptoms for proper monitoring and identification of necessary next steps
Symptoms Translation/Description 01 Fever Lagnat/ang body temperature ay 37.5 C o
higit pa 02 Cough Ubo
03 General weakness Panghihina ng katawan
04 Fatigue/Tiredness Pagkapagod
05 Headache Pananakit ng ulo
06 Muscle/joint/body pains Pananakit ng katawan, kalamnan, kasu-kasuan 07 Sore
throat Pananakit o pamamaga ng lalamunan
08 Colds/runny nose Sipon
09 Difficulty of breathing Pagkahapo o hirap sa paghinga
10 Loss of appetite Kawalan ng ganang kumain
11 Nausea Nasusuka
12 Vomiting Pagsusuka
13 Diarrhea Pagtatae
14 Loss of smell Pagkawala ng pang-amoy
15 Loss of taste Pagkawala ng panlasa
Rashes
16 17 Others Mga sintomas o obserbasyon sa pangangatawan o pagkilos
Mga butlig sa balat; pamumula ng balat (maaaring makati o ng tao/bata na kailangan ng atensyong medikal
hindi)
Paalala sa mga Magulang/Guardian
Kung ang inyong anak po o ang sinuman sa inyong sambahayan ay kasalukuyang nakararanas o
nakaranas sa nakalipas na 14 na araw ng alinman sa mga sumusunod na sintomas, mangyari pong
huwag na munang papasukin ang bata sa eskwela.

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Huwag din po munang papasukin sa eskwelahan ang inyong anak kung siya o ang sinuman sa inyong
sambahayan ay nagpositibo sa COVID-19, naging close contact ng COVID-19 case, o nadiagnose sa
pneumonia.

Ipagbigay alam po agad ang sitwasyon sa kanilang guro na si G/Gng/Bb. _______________, sa

numero bilang ___________________, upang maisaayos ang alternative delivery mode para sa
kanilang pag-aaral habang sila ay nasa bahay.

Mangyari pong imonitor ang kondisyon ng inyong anak o kasama sa bahay, at iulat sa inyong
Barangay Health Emergency Response Team (BHERT), Barangay Health Station, o Rural Health Unit,
kung kinakailangan, upang sila ay mabigyan ng kaukulang lunas.

Ipinapabatid din po ng pamunuan ng ___________________________________ na imomonitor po

ng kanilang mga guro ang mga mag-aaral na pumapasok sa paaralan at ipagbibigay-alam agad sa
inyo at sa mga kinauukulan kung sila ay ma-obserbahan o maiulat na nakakaranas ng alinman sa
mga sintomas na nabanggit sa itaas.

Mangyari pong itago o idisplay sa inyong bahay ang paalalang ito upang magsilbing gabay para sa
Notice to Reporting Personnel

By proceeding to report to school today, you guarantee the school management that neither you nor
any member of your household experiences any of the following symptoms:

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You also confirm that neither you nor any member of your household is currently tagged as COVID-
19 positive or a close contact of a COVID-19 positive case, or has been diagnosed with pneumonia.
 If you experience any of the above listed symptoms while you are in school, kindly report
immediately to the School Clinic for appropriate assessment and/or referral as needed.
Health Declaration Form

Source: COMELEC (Note: Ask DOH of standard declaration form, and appropriate action per
reported information [e.g., do not allow entry if they checked "yes" to any statement?], if
available.)
CLASSROOM DAILY HEALTH MONITORING TOOL FOR COVID-19

Grade Level: Section:

Instruction: Write under each column date the code(s) of the symptom(s) observed in the learner during the routine inspection, during the conduct of the class, or as
reported by the learner or their classmates. Refer to the list of symptoms below and their respective codes:

Fv Fever F/T Fatigue/Tiredness ST Sore throat LoA Loss of appetite D Diarrhea R Rashes C Cough HA Headache C/RNColds/runny nose N Nausea LoS Loss of smell Others
 NAME Symptoms Observed/Reported

2021-09-13 2021-09-14 2021-09-15 2021-09-16 2021-09-17

Monday Tuesday Wednesday Thursday Friday

Note: As soon as any of the listed symptoms is observed among any of the learners, the teacher is expected to send the learner to the School Clinic immediately for the
proper management by the School Clinic Teacher or health personnel.

Submitted by: Noted by:

Classroom Adviser Clinic Teacher

Procedure for Reporting, Management, and Referral
Person Activities Means of Verification Resources Needed
Note: In case of life-threatening emergency, bring the learner to the nearest health facility as soon as possible, while informing the parent of the situation. Necessary first aid must
be provided until the learner is attended by the medical personnel in the facility.

Step 1 (Option 1) Step 2a (Option 2) Step 2 of the condition of

Classroom teacher Performs initial/basic asssessment the learner (either through
(Option 1) Step 2b
routine inspection or as observed Clinic assistant Fetches the symptomatic learner from Daily Health Monitoring Tool for COVID-19 Clinic assistant
Classroom teacher Sends text message to the Clinic the classroom to the clinic Thermometer, printed health monitoring tool (1 sheet
Teacher informing them about Classroom assistant Accompanies the symptomatic per week per class) Classroom assistant
the symptomatic learner learner to the clinic Mobile phone with load

Step 3a Clinic teacher/nurse Logs the information of the Logsheet (Name, reported
symptoms)
Step 3b Clinic teacher/nurse Assesses condition of the learner
learner
(Verify the symptoms)

Emergency Step 4 Step 4a nearest health facility (e.g., Mobile phone with load; contact
prepare referral slip, facilitate information of the Medical Officer
Clinic teacher/nurse Contacts the DepEd Medical Officer or the assigned for the school and of the
MHO/RHU doctor MHO/RHU doctor; ensure
Clinic teacher/nurse Provides first aid treatment and initiates necessary (in case there is no DepEd
preparations Medical Officer)
for sending the learner to the Referral Slip Referral Slip
DepEd Medical Messenger/Viber) condition of the learner if Logsheet (Remarks; that parent was notified and
Officer/MHO/RHU doctor arrangement with the MHO/RHU instructed by the Medical Officer, informed about the medication to be given)
Step 4b Mobile phone with load (access to messenger/viber); notifies the parent about the ~Mobile phone with load; contact information of the
Provides instruction to the clinic teacher (which may Prescription/Instruction Slip Medical Officer's instruction, parent
include reporting to the BHERT or sending to the including prescribed treatment ~Consent to participate in the F2F classes must cover
nearest hospital facility as needed, based on the or medication, and asks the consent to allow management of symptoms while in
assessment of the Medical parent to fetch the child from school (including sending to health facility in case of
school, if needed emergency, reporting to BHERT, as needed), as well as
Logsheet (Doctor's order);
crucial information about the learner's health (e.g.,
Photo/Soft copy of
Step 4b.i (As needed) allergies, medications, etc.) Note: This particular
Prescription/Instruction Slip (Sent through Clinic teacher/nurse Contacts the parent about the Clinic teacher/nurse Makes necessary preparations section will be

Step 4b.ii (As needed) and coordination to send the learner to the nearest health facility, if information of the nearest health
instructed by the Medical Officer facilities; Referral Slip
Logsheet (Referred to); Referral Slip Mobile phone with load; contact

Step 4b.iii (As needed) Logsheet (Remarks; Reported case); copy of BHERT that has jurisdiction to the residence of the Slip (report to BHERT)
Clinic teacher/nurse Contacts the BHERT, if instructed communications to the BHERT (at least text message) learner (Clinic needs list of contact information of all
by the Medical Officer Mobile phone with load; contact information of the BHERTs of the learners reporting to the school); Action

Clinic teacher/nurse Provides first aid treatment as instructed by the Medical Officer
 Step 5 nebulizer, forceps, BP apparatus,
Logsheet (Doctor's order) Medicines to address symptoms; first aid kit; other equipment (non-contact oxygen tank, sterilizer); (Refer to list of
thermometer, pulse oximeter, equipment that must be present in the
clinic before the school is allowed to
Path 1
(Option 1) Step 6 Clinic assistant Accompanies the learner back to the classroom once cleared
(Option 2) Step 6 Classroom assistant Fetches the learner from the clinic to the classroom once
Path 2a (If parent is asked to fetch the child; from 4bi) cleared
Step 6 Parent Arrives in the school to fetch the learner MGH Slip, including list of
Step 8 Clinic teacher/nurse Follows-up on the condition of reminders/instructions for the parent (including what to monitor; need to
Clinic teacher/nurse Provides instruction/important information to the report to BHERT as needed; need to inform school if the learner tests
parent Logbook (Remarks); "May Go Home"/MGH Slip (with copy signed by the positive; when to seek clearance prior
parent, to be left to the Guard and then returned to the Clinic)
Step 7
the learner, including results of COVID-19 test (if applicable) Logsheet (Follow-up status) Mobile phone with load; contact information of the parent
The School Head, together with the clinic teacher, is expected to prepare a summary of reported/managed/referred learners, and their condition. Path
2b (For COVID cases; if learner is referred to BHERT; from 4biii)

Step 9a Step 9b Classroom teacher/clinic teacher/nurse Receives information from BHERT/parent that the Parent's consent form must include a provision that
learner(s) is/are positive for COVID-19 Informs the parents are required to report to the school the
Classroom teacher/clinic teacher/nurse school head about the case(s) COVID-19 test results of their children

Step 10a Incident report

School head Convenes concerned personnel to inititate contact tracing Step 11b
among the classmates and respective BHERTs incident reports, providing information about the situation, and the list
teacher(s) of the positive case(s)
Step 10b School head Prepares the list of all close contacts of the positive
case(s)

Step 11a School head Informs the families of the close contacts about the situation
School head Informs and submits to their

Step 12 School head Follows-up on the condition of the close contacts, including
Reminders: results of COVID-19 tests (if

1. Medical certificate/clearance may be required before learners are allowed to return to face-to-face classes, subject to the approval of the DepEd Medical Officer.

2. There must be avaible alternate clinic teachers/nurses to take over the management of the clinic in case the first batch of clinic teachers/nurses become close contacts of a
positive case or test positive for COVID-19.
Date Time Name Age Sex Grade & Teacher Adviser Chief Complaint(s) Doctor's Order Treatment Administered By Remarks Follow-up Status
Admitt Section [Reason(s) for the clinic [To be initialed by the Medical [Indicate how the instructions of the doctor were [As needed; Date/Status]
ed visit/reported Officer upon visit]/ Supported by followed, as well as other actions taken; e.g., ordered to
symptom(s)] the doctor's return to classroom, what time; reported to BHERT,
Prescription/Instruction Slip specify contact number; informed the parent about
instructions, fetched by; etc.]

_ Administer treatment Paracetamol 5ml, given

_ Contact the parents at 10:30 am
_ Refer to health facility
_ Report to BHERT
 SUMMARY OF HEALTH STATUS OF PERSONNEL AND LEARNERS
For the Month of: ________________
School
Name Category Grade Level/Section Date Reported Symptom(s) Action Taken COVID-19 Status
(Personnel/Learner) Observed/Reported (Referred to) per Follow-Up

(Positive/Negative)
MAY GO HOME SLIP

Date:
Name
Age
Sex
Grade/Section
Teacher-Adviser

This certifies that the learner has been provided initial management at the clinic, with instructions from:
Name of Doctor:

The doctor has given instruction that the learner may go home/be fetched by his/her

parent/guardian. Signed:

Clinic Teacher/Nurse

This certifies that I have been provided important information/instructions by the clinic teacher/nurse:

Signed:
Name of fetcher:
Relation to the child:
Time fetched:

Present this May Go Home Slip and cut and leave the upper portion of the slip to the guard before leaving the school.

This lower portion may be brought home by the parent/fetcher.

REMINDERS TO THE PARENT

_ Please monitor the following:

_ Please consult with…

_ Your child has been reported to the BHERT ( __________________ ); please coordinate with them for the next
steps _ Please inform the school immediately if your child tests positive for COVID-19.
_ Medical certificate/clearance is required before the learner is allowed to return to face-to-face classes, subject
to the approval of the DepEd Medical Officer.

Other instructions:
<Address>

<Name of Doctor>
<Position>
List of symptoms (per DOH DM 2020-0512)

PMA