Republic of the Philippines

Department of Education
________________________________________________________________________________________________________

CLASSROOM DAILY HEALTH MONITORING TOOL FOR COVID-19

Grade Level: 6 CLASS A Section: DIAMOND

Instruction: Write under each column date the code(s) observed in the learner during the routine inspection, during the conduct of
t he 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 - Nause
LoA - 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 2022-06-20 2022-06-21 2022-06-22 2022-06-23 2022-06-24
Monday Tuesday Wednesday Thursday Friday
1. BOQUEO,ZYMON, BATUYONG
2. BULOSAN,JHON CARL, ORPILLA
3. BULOSAN,WARREN, GESTA
4. CABEL,JHAYMUEL OSWALD,
5. CARIÑO,RONALD MATTHEW, CARIAGA
6. PASCUAL,JOHARD JAMES, AGUINALDO
7. SARIAN,GIOVANN YZEKIEL, BULOSAN
8. RAMOS,DIEL ROSLEE, SOSA
9. RAMOS,KEAN TRISTAN, BULOSAN
10. SOSA,CARL ZANDER, ANDRES
11. AGPAOA,GWENN JUNIZEL, BULOSAN
12. AGUITE,NEFA VENYXANETTE, UCOL
13. ALNAS,CRIZYA JOY, MARQUEZ
14. CABASAG,RIMA JHELIENA, ABIAN
15. CALDITO,LHINZEN KHAILE, GARCIA
16. CALILAN,CHLOE SOPHIA, RAMO
17. GARAZA,KATELYN JOY, BAGARES
18. TAMBIO,CAITLIN SUPHIA, LAWIGAN

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 ClinicTeacher or health
personnel.

Submitted by: Noted by:

JENNELYN R. CALILN HELIDEL R. LAGAZO

____________________ ____________________________
Classroom Adviser Clinic Teacher
 Republic of the Philippines
Department of Education
Region I
SCHOOLS DIVISION OF ILOCOS NORTE
________________________________________________________________________________________________________
NAGSANGA EEMENTARY SCHOOL
PASUQUIN DISTRICT
CLASSROOM DAILY HEALTH MONITORING TOOL FOR COVID-19

Grade Level: 6 CLASS B Section: DIAMOND

Instruction: Write under each column date the code(s) observed in the learner during the routine inspection, during the conduct of
t he 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 - Nause
LoA - 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 2022-06-20 2022-06-21 2022-06-22 2022-06-23 2022-06-24
Monday Tuesday Wednesday Thursday Friday
1. CARIÑO, CYDRICK JAMES BALATICO
2. DALO,KEISEN JASPER, GAGARIN
3. FAILMA,JOHN, -
4. GARAZA,KAEZELL JOY, CALILAN
5. LICUAN,JAYLORD, DANCEL
6. MAGNO,JOVEN, GALOT
7. SALVADOR,JOHN DAVE, B
8. AGUDELO,MARIEL JHAYNE, ALMOJUELA
9. AGUILA,KRISTELYNE, CALPO
10. CALARAMO, JEMAICA MIZHICA
SALVADOR
11. CELSO,CRISTEL MAE, BULOSAN
12. CORNELIO,KATHY JOY, UDAUNDO
13. MAGANA,ANTONETTE, MANAYAN
14. MANZANO,DANIA MEI, LLAPITAN
15. RAMOS,TRIXHIA MAE, GARAÑO
16. TANGONAN,DIANA CAMILLE, ANTONIO
17. UDARBE, ANGEL LABUGUEN

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 ClinicTeacher or health
personnel.

Submitted by: Noted by:

JENNELYN R. CALILN HELIDEL R. LAGAZO

____________________ ____________________________
Classroom Adviser Clinic Teacher