Republic of the Philippines

Department of Education
________________________________________________________________________________________________________

WILBUR C. GO NHS
CLASSROOM DAILY HEALTH MONITORING TOOL FOR COVID-19

Grade Level: ____12___ Section: Onyx

Instruction: Write under each column date the code(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/RN - Colds/Runny nose N - Nausea
LoS - 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
Monday Tuesday Wednesday Thursday Friday
Carlo C. Constantino EN EN EN
Erwin V. Constantino EN EN EN
Francis Armand G. Dumlao EN EN EN
Jhon-Jhon O. Gajes EN EN EN
Marc Stephen L. Galarce EN EN EN
Angelo A. Gozon EN EN EN
Dexter A. Gozon EN EN EN
Tayshaun Andrei L. Labangcoc EN EN EN
Shan David Pacana EN EN EN
Jhony R. Pagal EN EN EN
Jefferson O. Pornobe EN EN EN
Kent Cedric D. Subia EN EN EN
Pablo Robert D. Yere EN EN EN
Jahanna Bea Lou EN EN EN
Debra Ann T, Sinay EN EN EN

No Ate: 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:

____Fernando L. Farias Jr ABIGAIL FAYE A. CAMIÑA, RN

Classroom Adviser School