Republic of the Philippines

Department of Education
CARAGA REGION
Division of Agusan Del Norte
Jabonga District II
BALEGUIAN ELEMENTARY SCHOOL

CLASSROOM DAILY HEALTH MONITORING TOOL FOR COVID-19

Grade & Section: VI Section: MABINI
Write under each column date the code(s) of the symptom(s) observed in the learner during the routine inspection, during the
conduct of class or as reported the learners or their classmates. Refer to the list symptoms below and the respective codes:
Fv Fever F/T Fatigue/TirednessST Sore Throat LoA Loss of Appetite D DiarrheaR Rashes

C Cough HA Headache C/RN Colds/Runny Rose N Nausea LoS Loss of Smell O others

SYMPTOMS OBSERVED/REPORTED
NAME OF PUPIL Date:_______ Date:_______ Date:_______ Date:_______ Date:_______
Monday Tuesday Wednesday Thursday Friday
AJOC,KIEVEN JAY, B
BUSTAMANTE,GIREMY, B
CAGADAS,GABRIEL, M
DUARTE,WYETH, P
GUADALUPE,MATT SEAN, A
MASLOG,JHONSORD, A
OLOR,JULIOS, JR AVELINO
SALUPADO,ESTEVE
MIGUEL, LOPEZ
ANASTACIO,LAVEÑA, A
BIOG,RHEA, B
BUSTAMANTE,SHANELLAIN
E MAE, D
CAPON,ASHLY KHY, A
DUARTE,KIM ROSE, P
MACABODBOD,MICHEL, M
MANSIGUIAO,JOHAZIEL, L
TABACON,JAYMARIE, J

Note: As soon as any of the listed symptom 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: ____________________________

Class Adviser Clinic Teacher

Republic of the Philippines

 Department of Education
CARAGA REGION
Division of Agusan Del Norte
Jabonga District II
BALEGUIAN ELEMENTARY SCHOOL

CLASSROOM DAILY HEALTH MONITORING TOOL FOR COVID-19

GRADE LEVEL: VI-MABINI Week: __________________ SECTION/CLASS: __________

Number
Number Reason of
NAME Monday Tuesday Wednesday Thursday Friday
of Tardy
of
tardiness/absences
Absence
AJOC,KIEVEN JAY, B
BUSTAMANTE,GIREMY, B
CAGADAS,GABRIEL, M
DUARTE,WYETH, P
GUADALUPE,MATT SEAN, A
MASLOG,JHONSORD, A
OLOR,JULIOS, JR AVELINO
SALUPADO,ESTEVE
MIGUEL, LOPEZ
ANASTACIO,LAVEÑA, A
BIOG,RHEA, B
BUSTAMANTE,SHANELLAINE
MAE, D
CAPON,ASHLY KHY, A
DUARTE,KIM ROSE, P
MACABODBOD,MICHEL, M
MANSIGUIAO,JOHAZIEL, L
TABACON,JAYMARIE, J

Prepared by:

__________________
Class Adviser

NOTED:
MARPE B. BOCO
School Head

Republic of the Philippines

Department of Education
CARAGA REGION
Division of Agusan Del Norte
Jabonga District II
BALEGUIAN ELEMENTARY SCHOOL

CLASSROOM DAILY HEALTH MONITORING TOOL FOR COVID-19

Grade & Section: _____________________________ Section: ___________________________
Write under each column date the code(s) of the symptom(s) observed in the learner during the routine inspection, during the
conduct of class or as reported the learners or their classmates. Refer to the list symptoms below and the respective codes:
Fv Fever F/T Fatigue/TirednessST Sore Throat LoA Loss of Appetite D DiarrheaR Rashes

C Cough HA Headache C/RN Colds/Runny Rose N Nausea LoS Loss of Smell O others

SYMPTOMS OBSERVED/REPORTED
NAME OF PUPIL Date:_______ Date:_______ Date:_______ Date:_______ Date:_______
Monday Tuesday Wednesday Thursday Friday
BAJAN,LANZ LEJEE, O
CABELLO,BRENT CZAR,
G
DUARTE,JHON CARL, H
GLORIANO,CARLO, S
LUISON,RICH DARRYL, A
ODTOHAN,JHON
LAWRENCE, S
ORAPA,RODILITO, O
AJOC,TRISHIA MAE, B
BIOG,ELENA, B
BUSCANO,JOANE, H
CANTILA,JEANNE
GRACE, M
CENIZA,JEAHMAE
PRECIOUS, T
ESPINOSA,VAÑEZA, C
MALDO,ALTHEA ELLAINE,
M
PEDERE,SHAHANIE
PRINCESS, D
SOMORAY,AXCEL ROSH,
T
TEMARIO,LJ, A

Note: As soon as any of the listed symptom 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: ____________________________

Class Adviser Clinic Teacher

Republic of the Philippines

Department of Education
CARAGA REGION
Division of Agusan Del Norte
Jabonga District II
BALEGUIAN ELEMENTARY SCHOOL

CLASSROOM DAILY HEALTH MONITORING TOOL FOR COVID-19

GRADE LEVEL: VI-MABINI Week: __________________ SECTION/CLASS: __________

NAME Monday Tuesday Wednesday Thursday Friday Number Number Reason of

of Tardy of tardiness/absences
 Absence
BAJAN,LANZ LEJEE, O
CABELLO,BRENT CZAR, G
DUARTE,JHON CARL, H
GLORIANO,CARLO, S
LUISON,RICH DARRYL, A
ODTOHAN,JHON
LAWRENCE, S
ORAPA,RODILITO, O
AJOC,TRISHIA MAE, B
BIOG,ELENA, B
BUSCANO,JOANE, H
CANTILA,JEANNE GRACE,
M
CENIZA,JEAHMAE
PRECIOUS, T
ESPINOSA,VAÑEZA, C
MALDO,ALTHEA ELLAINE,
M
PEDERE,SHAHANIE
PRINCESS, D
SOMORAY,AXCEL ROSH,
T
TEMARIO,LJ, A

Prepared by:

__________________
Class Adviser

NOTED:
MARPE B. BOCO
School Head