Republic of the Philippines

Department of Education
REGION I
SCHOOLS DIVISION OFFICE OF URDANETA CITY
MARIANO Q. UMIPIG NATIONAL HIGH SCHOOL
______________________________________________________________________
WASH IN SCHOOL (WinS) PROGRAM
SY-2021-2022
MONITORING TOOL FOR HANDWASHING ACTIVITY AT HOME
For the Month of ________________

NAME OF LEARNER: ______________________________________________________________

NAME OF PARENT/GUARDIAN: _____________________________________________________
GRADE: 7 – Gold

DAY Is Hand How many Products Used PARENT/ ADVISER

Hygiene times GUARDIAN SIGNATURE -
Opportunity handwashin Soap Alcohol- SIGNATURE DATE
successful? g was and based
performed? Water Sanitizer
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JOVY MAY T. AGSALUD IMELDA E. PALAD

Adviser/School Clinic Teacher Principal III
 Republic of the Philippines
Department of Education
REGION I
SCHOOLS DIVISION OFFICE OF URDANETA CITY
MARIANO Q. UMIPIG NATIONAL HIGH SCHOOL
______________________________________________________________________

WASH IN SCHOOL (WinS) PROGRAM

SY-2021-2022
MONITORING TOOL FOR HANDWASHING ACTIVITY AT HOME
For the Month of ________________

NAME OF LEARNER: ______________________________________________________________

NAME OF PARENT/GUARDIAN: _____________________________________________________
GRADE: 7 – JADE

DAY Is Hand How many Products Used

Hygiene times PARENT/ ADVISER
Opportunity handwashin Soap Alcohol- GUARDIAN SIGNATURE -
successful? g was and based SIGNATURE DATE
performed? Water Sanitizer
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MARA G. PELAEZ IMELDA E. PALAD

Adviser Principal III
 Republic of the Philippines
Department of Education
REGION I
SCHOOLS DIVISION OFFICE OF URDANETA CITY
MARIANO Q. UMIPIG NATIONAL HIGH SCHOOL
______________________________________________________________________
WASH IN SCHOOL (WinS) PROGRAM
SY-2021-2022
MONITORING TOOL FOR HANDWASHING ACTIVITY AT HOME
For the Month of ____________

NAME OF LEARNER: ______________________________________________________________

NAME OF PARENT/GUARDIAN: _____________________________________________________
GRADE: 8 - Emerald

DAY Is Hand How many times Products Used

Hygiene handwashing PARENT/
Soap Alcohol- ADVISER
Opportunity was performed? GUARDIAN
and based SIGNATURE - DATE
successful? SIGNATURE
Water Sanitizer
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JINKY LORRAINE A. RUIZ IMELDA E. PALAD

Adviser Principal III
 Republic of the Philippines
Department of Education
REGION I
SCHOOLS DIVISION OFFICE OF URDANETA CITY
MARIANO Q. UMIPIG NATIONAL HIGH SCHOOL
______________________________________________________________________

WASH IN SCHOOL (WinS) PROGRAM

SY-2021-2022
MONITORING TOOL FOR HANDWASHING ACTIVITY AT HOME
For the Month of ____________

NAME OF LEARNER: ______________________________________________________________

NAME OF PARENT/GUARDIAN: _____________________________________________________
GRADE: 8-Garnet

DAY Is Hand How many Products Used

Hygiene times PARENT/ ADVISER
Opportunity handwashing GUARDIAN SIGNATURE -
successful? was Soap Alcohol-
and based SIGNATURE DATE
performed?
Water Sanitizer
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KATHERINE B. LIBARDE IMELDA E. PALAD

Adviser Principal III
 Republic of the Philippines
Department of Education
REGION I
SCHOOLS DIVISION OFFICE OF URDANETA CITY
MARIANO Q. UMIPIG NATIONAL HIGH SCHOOL
______________________________________________________________________

WASH IN SCHOOL (WinS) PROGRAM

SY-2021-2022
MONITORING TOOL FOR HANDWASHING ACTIVITY AT HOME
For the Month of ___________

NAME OF LEARNER: ______________________________________________________________

NAME OF PARENT/GUARDIAN: _____________________________________________________
GRADE: 9-SAPPHIRE

DAY Is Hand How many Products Used

Hygiene times Soap Alcohol- PARENT/ ADVISER
Opportunity handwashin and based GUARDIAN SIGNATURE -
successful? g was Water Sanitize SIGNATURE DATE
performed? r
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PASTOR O. MARCOS JR. IMELDA E. PALAD

Adviser Principal III
 Republic of the Philippines
Department of Education
REGION I
SCHOOLS DIVISION OFFICE OF URDANETA CITY
MARIANO Q. UMIPIG NATIONAL HIGH SCHOOL
______________________________________________________________________

WASH IN SCHOOL (WinS) PROGRAM

SY-2021-2022
MONITORING TOOL FOR HANDWASHING ACTIVITY AT HOME
For the Month of __________

NAME OF LEARNER: ______________________________________________________________

NAME OF PARENT/GUARDIAN: _____________________________________________________
GRADE: 9-Pearl

DAY Is Hand How many Products Used

Hygiene times PARENT/ ADVISER
Opportunity handwashing Soap Alcohol- GUARDIAN SIGNATURE -
successful? was and based SIGNATURE DATE
performed? Water Sanitizer
1
2
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HAROLD MERCADO IMELDA E. PALAD

Adviser Principal III
 Republic of the Philippines
Department of Education
REGION I
SCHOOLS DIVISION OFFICE OF URDANETA CITY
MARIANO Q. UMIPIG NATIONAL HIGH SCHOOL
______________________________________________________________________

WASH IN SCHOOL (WinS) PROGRAM

SY-2021-2022
MONITORING TOOL FOR HANDWASHING ACTIVITY AT HOME
For the Month of _________

NAME OF LEARNER: ______________________________________________________________

NAME OF PARENT/GUARDIAN: _____________________________________________________
GRADE: 10-Diamond

DAY Is Hand How many Products Used

Hygiene times PARENT/ ADVISER
Opportunity handwashin Soap Alcohol- GUARDIAN SIGNATURE -
successful? g was and based SIGNATURE DATE
performed? Water Sanitizer
1
2
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LEAH M. SALVADOR IMELDA E. PALAD

Adviser Principal III
 Republic of the Philippines
Department of Education
REGION I
SCHOOLS DIVISION OFFICE OF URDANETA CITY
MARIANO Q. UMIPIG NATIONAL HIGH SCHOOL
______________________________________________________________________

WASH IN SCHOOL (WinS) PROGRAM

SY-2021-2022
MONITORING TOOL FOR HANDWASHING ACTIVITY AT HOME
For the Month of __________

NAME OF LEARNER: ______________________________________________________________

NAME OF PARENT/GUARDIAN: _____________________________________________________
GRADE: 10-RUBY

DAY Is Hand How many Products Used

Hygiene times Soap Alcohol- PARENT/ ADVISER
Opportunity handwashing and based GUARDIAN SIGNATURE -
successful? was Water Sanitizer SIGNATURE DATE
performed?
1
2
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RIZA M. PALISOC IMELDA E. PALAD

Adviser Principal III
 Republic of the Philippines
Department of Education
REGION I
SCHOOLS DIVISION OFFICE OF URDANETA CITY
MARIANO Q. UMIPIG NATIONAL HIGH SCHOOL
______________________________________________________________________

WASH IN SCHOOL (WinS) PROGRAM

SY-2021-2022
MONITORING TOOL FOR HANDWASHING ACTIVITY AT HOME
For the Month of ___________

NAME OF LEARNER: ______________________________________________________________

NAME OF PARENT/GUARDIAN: _____________________________________________________
GRADE: 11 STEM

DAY Is Hand How many Products Used

Hygiene times Soap Alcohol- PARENT/ ADVISER
Opportunity handwashin and based GUARDIAN SIGNATURE -
successful? g was Water Sanitizer SIGNATURE DATE
performed?
1
2
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JOB B. LIPADAN IMELDA E. PALAD

Adviser Principal III
 Republic of the Philippines
Department of Education
REGION I
SCHOOLS DIVISION OFFICE OF URDANETA CITY
MARIANO Q. UMIPIG NATIONAL HIGH SCHOOL
______________________________________________________________________

WASH IN SCHOOL (WinS) PROGRAM

SY-2021-2022
MONITORING TOOL FOR HANDWASHING ACTIVITY AT HOME
For the Month of __________

NAME OF LEARNER: ______________________________________________________________

NAME OF PARENT/GUARDIAN: _____________________________________________________
GRADE: 11 GAS

DAY Is Hand How many Products Used

Hygiene times PARENT/ ADVISER
Opportunity handwashing Soap Alcohol- GUARDIAN SIGNATURE -
successful? was and based SIGNATURE DATE
performed? Water Sanitizer
1
2
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 Republic of the Philippines
Department of Education
REGION I
SCHOOLS DIVISION OFFICE OF URDANETA CITY
MARIANO Q. UMIPIG NATIONAL HIGH SCHOOL
______________________________________________________________________
PRINCE LEE P. ANGELO IMELDA E. PALAD
Adviser Principal III

WASH IN SCHOOL (WinS) PROGRAM

SY-2021-2022
MONITORING TOOL FOR HANDWASHING ACTIVITY AT HOME
For the Month of __________

NAME OF LEARNER: ______________________________________________________________

NAME OF PARENT/GUARDIAN: _____________________________________________________
GRADE: 12 STEM

DAY Is Hand How many Products Used

Hygiene times PARENT/ ADVISER
Opportunity handwashing GUARDIAN SIGNATURE -
Soap Alcohol-
successful? was SIGNATURE DATE
and based
performed? Water Sanitizer
1
2
3
4
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ABEGAIL J. BAYAO IMELDA E. PALAD

 Republic of the Philippines
Department of Education
REGION I
SCHOOLS DIVISION OFFICE OF URDANETA CITY
MARIANO Q. UMIPIG NATIONAL HIGH SCHOOL
______________________________________________________________________
Adviser Principal III

WASH IN SCHOOL (WinS) PROGRAM

SY-2021-2022
MONITORING TOOL FOR HANDWASHING ACTIVITY AT HOME
For the Month of ___________

NAME OF LEARNER: ______________________________________________________________

NAME OF PARENT/GUARDIAN: _____________________________________________________
GRADE: 12 GAS

DAY Is Hand How many Products Used

Hygiene times PARENT/ ADVISER
Opportunity handwashin GUARDIAN SIGNATURE -
Soap Alcohol-
successful? g was SIGNATURE DATE
and based
performed? Water Sanitizer
1
2
3
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 Republic of the Philippines
Department of Education
REGION I
SCHOOLS DIVISION OFFICE OF URDANETA CITY
MARIANO Q. UMIPIG NATIONAL HIGH SCHOOL
______________________________________________________________________
VICTOR E. CORPUZ IMELDA E. PALAD
Adviser Principal III