SUMMARY OF HEALTH STATUS OF PERSONNEL AND LEARNERS

For the Month of: __________________________

School:

Category Symptom(s)
Name Grade Level/Section Date Reported Action Taken (Referred to) COVID-19 Status per Follow-Up
(Personnel/Learner) Observed/Reported
 CHIEF DOCTOR'S ORDER REMARKS (Indicate how the instruction of the doctor
TIME GRADE & COMPLAINT(S) were followed, as well as other actions taken; e.g. ordered Follow-Up Status (as
DATE NAME AGE/SEX TEACHER - ADVISER (to be initialed by the Medical TREATMENT to return to classroom, what time, reported to BHERT,
ADMITTED SECTION reasons for the clinic Officer upon visit/Supported by the specify contact number, informed the parent about needed, date/status)
visit/reported symptoms doctor's prescription/Instruction Slip) instruction, fetched by, etc.)
 CLASSROOM DAILY HEALTH MONITORING TOOL FOR COVID-19
SECTION: MACAPAGAL
GRADE LEVEL: 9
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 - sorethroat LoA - loss of appetite D - Diarrhea R- rashes

C - cough HA - headache C/RN - colds/runny noseN - Nausea LoS - loss of smell O - others
SYMPTOMS OBSERVED/ REPORTED
NAME
MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY

AQUINO, TJ G.
CASANOVA, RACHELLE A.
CASANOVA, RACQUEL A.
CORCUERA, JEZREELITA C.
DAZER, LIZA O.
EUGENIO, NICOLE P.
HILIG, JOHN WAYNE I.
INGOTE, ALDRICH F.
MACAWILI, YESHAMINE D.
MAMONTOS, STEPHANIE P.
MINTAC, JOHN REY M.
PADUA, JOHN LEE P.
PASCUA, ASHLEY NICOLE C.
QUIDAWEN, SHEKAINAH MAE E.
RAMIREZ, JULIE R.
TUBA, DHAN VINCENT T.
ZUNIGA, RYNNAH.

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
proper management by the School Clinic Teacher or health personnel.
Submitted by: Noted by:

Classroom Adviser RONA J. GONZALES Clinic Teacher LILIAN M. FERNANDEZ