Republic of the Philippines

Department of Education
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CLASSROOM DAILY HEALTH MONITORING TOOL FOR COVID-19

Grade Level: _________________________ Section: ______________________

Instruction: Write under each column date the code(s) observed in the learner during the routine inspection, during the conduct of
t he 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/RN - Colds/Runny nose N - Nause
LoA - Loss of Smell EN - Essentially normal GW - General Weakness DB - Difficulty of breathing Vm - Vomiting
Lot - Loss of Taste M/BP-Muscle/joint/body pain A - Absent

Symptoms Observed/Reported
NAME 2021-11-15 2021-11-16 2021-11-17 2021-11-18 2021-11-19
Monday Tuesday Wednesday Thursday Friday
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.

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 ClinicTeacher or health
personnel.

Submitted by: Noted by:

____________________ ____________________________
Classroom Adviser Clinic Teacher