Enclosure to DepEd-DOH Joint Memorandum Circular on the Operational Guidelines on the Pilot Implementation of Face-to-

face Learning Modality

Republic of the Philippines

Department of Education
REGION IV - A (CALABARZON)
SCHOOLS DIVISION OF IMUS CITY
GEN. JUAN CASTAÑEDA SENIOR HIGH SCHOOL

Annex G:
Notice to Reporting Personnel

By proceeding to report to school today, you guarantee the school management that neither you nor any
member of your household experiences any of the following symptoms:
a. Fever f. Fatigue/ Tiredness
b. Cough and colds g. Headache
c. Difficulty of breathing h. Loss of taste or smell
d. Sore throat i. Body pains
e. Diarrhea

You also confirm that neither you nor any member of your household is currently tagged as COVID-19
positive, or a close contact of a COVID-19 case or has been diagnosed with pneumonia.

If you experience any of the above-listed symptoms while you are in school, kindly report immediately to
the School Clinic for appropriate assessment and/or referral as needed.

Source: COMELEC (Note: Ask DOH of standard declaration form, and appropriate action per
reported information [e.g., do not allow entry if they checked "yes" to any statement?], if available.)
Health Declaration Form