Republic of the Philippines

Department of Education
Region VI-Western Visayas
SCHOOLS DIVISION OF KABANKALAN CITY
District of Kabankalan IV
BANTAYAN NATIONAL HIGH SCHOOL

CLASSROOM DAILY HEALTH MONITORING TOOL FOR COVID-19

Grade Leve: _________________________ Section: ________________________
Instruction: Write under each column date the code(s) observe in the learner during the routine inspection, during the conduct of the class, or as a reported by
the learner or their classmates. Refer to the list of symptoms before their respective codes.
F- Fever CC-Cough and colds D B- Difficulty of breathing ST- Sore throat D -Diarrhea
FT - Fatigue/ Tiredness H- Headache LT/LS - Loss of taste or smell BP - Body pains

Monday Tuesday Wednesday Thursday Friday

Date: Date: Date: Date: Date:

Note: As soon as any of the symptoms is observe 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:

__________________________________ __________________________________
Class Adviser Clinic Teacher

Address: Purok 5, Bantayan, Kabankalan City, Negros Occidental

E-mail: Bantayan.jhs@gmail.com