Republic of the Philippines

Department of Education
REGION III
SCHOOLS DIVISION OFFICE OF PAMPANGA
Macabebe east district
Telacsan elementary School
MACABEBE, PAMPANGA

CLASSROOM DAILY HEALTH MONITORING TOOL FOR COVID-19 (SET A)

Grade Level: _Five_ Section: _Rizal_

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 their respective codes:

F 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 Others

Symptoms Observed/Reported
NAME Date: Date: Date: Date: Date:
Monday Tuesday Wednesday Thursday Friday
BERNARDO,ORLAND JAMES, PUYOD
CABBAB,AL JHUNE, TOLENTINO
CANILAO,ALEX CLARK, MICLAT
CEPE,ISHMAEL COLLIN, MANLAPAZ
FABIAN,JA STANIELLE, INEDO
ALEJO,MICHELLE LOURDES, MANANSALA
BERNABE,HEART FATIMA, FABIAN
CANLAS,AMIEE TIFFANY, NABONG
LAGOSTA,JILLIAN ALLYSON, ENRIQUEZ
LOBO,ERICA MIEL, TRINIDAD

Note: 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.

Prepared by: LESTER S. CANILAO Noted by: GLENDA C. HERNANDEZ

Grade 5 - Rizal Adviser Clinic Teacher / Health Leader

CLASSROOM DAILY HEALTH MONITORING TOOL FOR COVID-19 (SET B)

Address: Telacsan, Macabebe, Pampanga
Telephone No. 0923-922-7626
eMail Address: telacsanelementary@gmail.com
 Republic of the Philippines
Department of Education
REGION III
SCHOOLS DIVISION OFFICE OF PAMPANGA
Macabebe east district
Telacsan elementary School
MACABEBE, PAMPANGA

Grade Level: _Five_ Section: _Rizal_

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 their respective codes:

F 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 Others

Symptoms Observed/Reported
NAME Date: Date: Date: Date: Date:
Monday Tuesday Wednesday Thursday Friday
GERNALIN,ADAM MURPHY, -
GONZALO,NHIGEL KENNETH, TUBIG
LACANLALE,BLAKE, PUNO
MAGTOTO,CHARLIE ANGELO, RIVERA
TOLENTINO,JOHN MICHAEL, -
RONQUILLO,BEA AMOR, FERNANDEZ
SAGMIT,ALIYAH ZOE, -
SARMENTA,CHENELLE FAITH, DE LEON
STA RITA,JEDDAH, LAMSEN
TIGLAO,CHARMAINE, LOPEZ

Note: 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.

Prepared by: LESTER S. CANILAO Noted by: GLENDA C. HERNANDEZ

Grade 5 - Rizal Adviser Clinic Teacher / Health Leader

Address: Telacsan, Macabebe, Pampanga

Telephone No. 0923-922-7626
eMail Address: telacsanelementary@gmail.com