CLASSROOM DAILY HEALTH MONITORING TOOL FOR COVID-19

Grade 11- CHRYSANTHEMUM

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 write 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 MJBP – Muscle/joint/body pains DB -Difficulty of Breathing Vm – Vomiting LoT – Loss of Taste A - Absent
Others: Please Specify
SYMPTOMS OBSERVED/REPORTED
DATE: DATE: DATE: DATE: DATE:
NAME
MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY
Male
1. Bahis, Jemuel D.
2. Baylosis, Remy B.
3. Bonifacio, John Marlo G.
4. Cubero, Reymark B.
5. Niegas, Crisante B.
6. Niegas, Christopher B.
7. Sulanting, Ryan C.
8. Yerro, Zosimo Z. III
Female
1. Gayon, Mary Jane D.
2. Mateo, Mary Ann T.
3. Tacan, Hannah Mary B.
4. Talan, Shiela Mae M.

Note: As soon as any of the listed symptoms is observed among any of the learners, the teacher is expected to call the attention of School Covid Coordinator to contact representative of BHERT to take action or
medication to the learner.

Submitted by: Noted:

KIMBEERLYN C. DOROMAS, T-I ADONIS B. TAGABAN, T-III

Class Adviser School Covid Coordinator
 Republic of the Philippines
Department of Education
Region XII
Division of South Cotabato
POLOMOLOK 4 DISTRICT
BONIFACIO R. TAGABAN SR. INTEGRATED SCHOOL
Brgy. Kinilis, Polomolok, South Cotabato
School ID: 500458

PROFILING OF LEARNERS
GRADE 11-CHRYSANTHEMUM (HUMSS)
S.Y. 2021-2022

NAME PARENTS WAY TO WITH

FULLY
(LAST NAME, GO TO COMOR
BIRTH DATE COMPLETE GUARDIA CONTACT VACCIN
NO. LRN FIRST NAME, FATHER’S MOTHER’S SCHOOL BIDITIES
(mm/dd/yyyy) ADDRESS N NUMBER ATED?
EXTENSION, NAME NAME W/PRV/ ?
(Y/N)
MIDDLE NAME) PUV (Y/N)
130726100007 *BAHIS, JEMUEL PRK 6, KINILIS, WILLIAM T. BAHIS JEANY O.
DIGNADICE 12/22/2004 POLOMOLOK, DIGNADICE
1 SOUTH
09501459193 PRV N Y
COTABATO
130726100009 *BAYLOSIS, REMY PRK 8, KINILIS, ERNIE S. LENY D. BUAN
BUAN 06/26/2004 POLOMOLOK, BAYLOSIS
2 SOUTH
09635970417 W N Y
COTABATO
130726090007 *BONIFACIO, JOHN PRK 5, KINILIS, DANNY BOY A. JOSEPHINE D.
MARLO 05/26/2004 POLOMOLOK, BONIFACIO GAYON
3 SOUTH
09156377222 PRV N Y
GAYON
COTABATO
130726090013 CUBERO, REYMARK PRK 9, KINILIS, CUBERO, HELEN T. BACLOR
BACLOR 10/20/2002 POLOMOLOK, ROSARIO
4 SOUTH
09757542270 W N Y
DUMANHOG
COTABATO
130726100041 NIEGAS, CRISANTE 08/07/2001 PRK 8,KINILIS, NIEGAS, DANTE BUAN,CRISTINA,
POLOMOLOK, ABAYAN DALA,
6 SOUTH
09358882995 PRV N Y
COTABATO
7 130726100040 NIEGAS, 09/07/2000 PRK 8, KINILIS, NIEGAS, DANTE BUAN,CRISTINA, 09358882995 PRV N Y
 CHRISTOPHER POLOMOLOK, ABAYAN DALA,
SOUTH
COTABATO
130726100046 *SULANTING, RYAN 04/02/2003 PRK 1, KINILIS, SULANTING, CARIAGA,MARY
POLOMOLOK, ROGER ANN,DANIEL,
8 SOUTH
09756029195 PRV N Y
GANDULAN
COTABATO
130726100049 *YERRO, ZOSIMO III 10/08/2004 PRK 2, KINILIS, YERRO, ZOSIMO ZULUETA,MARIT
ZULUETA POLOMOLOK, DADULO JR EL,LIM,
9 SOUTH
09486054574 PRV N Y
COTABATO
130726100030 *GAYON, MARY JANE PRK 9, KINILIS, MAX L. GAYON MARCILA DALA
DALA 12/03/2002 POLOMOLOK, GAYON
10 SOUTH
09630684730 W N Y
COTABATO
130726100038 *MATEO, MARY ANN 05/13/2005 PRK 6, KINILIS, MATEO, DANIEL TORIAL,ROSA,B
TORIAL POLOMOLOK, NAVARRO ETONIO,
11 SOUTH
09516563553 W N Y
COTABATO
130734100045 *TACAN, HANNAH 06/12/2005 PRK 7, KINILIS, TACAN, MARIO BAHIS,THELMA,T
MARY BAHIS POLOMOLOK, JOEY ANGELES EJANO,
12 SOUTH
09129109891 PRV N Y
COTABATO
316619110091 TALAN, SHIELA MAE 03/29/1998 PRK 1, KINILIS, TALAN, EDGAR MASANA,MERCY
MASANA POLOMOLOK, M ,MAD,
13 SOUTH
09488498768 W N Y
COTABATO
131290100234 *ZULUETA, JENNY 11/16/2004 PRK 2, KINILIS, YERRO, RICKY YERRO,JOVELY
GWEN YERRO POLOMOLOK, LIM N,DADULO,
14 SOUTH
09635655614 W N Y
COTABATO

Prepared by:

KIMBEERLYN C. DOROMAS, T-I

Class Adviser