Wawa National High School

Teacher’s Health Declaration Log

NAME:
Are you experiencing:
Sore throat ? Body pains ? Fever for the Have you Have you had Have you Have you SIGNATURE
past few worked any contact travelled travelled to
days? together or with anyone outside of the any area in
Date Temperature stayed in the with fever, Philippines in NCR aside
same close cough, colds, the last 14 from your
environment and sore days? home?
of a confirmed throat in the
COVID-19 past 2 weeks?
case?
Name:
Page ___ of ____

Are you experiencing:

Sore throat ? Body pains ? Fever for the Have you Sore throat ? Body pains ? Fever for the Have you
past few days? worked past few days? worked
together or together or
Date Temperature
stayed in the stayed in the
same close same close
environment of environment of
a confirmed a confirmed
COVID-19 case? COVID-19 case?