SCHOOL SAFETY ASSESSMENT TOOL (SSAT) 2022

VALIDATION GUIDE

School Name: I Division:

School ID: I Contact Number:
School General Classification: Public Private

Main Area/Component/Indicator Mode of Complian Remarks

Verification/ t /
Evidence Yes No Recomm
endation
MANAGING SCHOOL OPERATIONS
INDICATORS

I. SHARED RESPONSIBILITY
Main Indicator:  Deed of Donations
 Acknowledgement
1. For Public schools, the school has receipts
mobilized resources and support from  Certificate of
Acceptance
community stakeholders to meet the
 Photo
standards of the health and safety Documentation
protocols.
Main Indicator:  Photo
Documentation/
2. The school has conducted simulation AVP
 Narrative Report
activities among school personnel
regarding protocols and routines to
replicate and discuss possible
scenarios during the actual conduct
of face to-face classes.
II. WORK ARRANGEMENT
Main Indicator:  Vaccination
1. The number of teachers who will Status Report
physically report meets the availability (Teaching and
of vaccinated teachers who handle Non-Teaching
personnel)
face-to-face classes in a safe learning
environment to learners.
Main Indicator:  Minutes of the
2. The school has oriented all its Meeting
personnel on the work arrangement  Photo
implemented during the face-to-face Documentation
classes.  Work
Arrangement for
F2F Classes
III. CLASSROOM LAYOUT AND STRUCTURE
Main Indicator:  Classroom Set up
1. The school has established based on max no.
mechanisms inside the classroom to of learners
 Floor/Hallway
ensure minimal to zero COVID-19
Markers
transmission of the learners and  Signages/Stickers
ensured that all heating, ventilation,  Availability of
and air conditioning systems are Electric Fans
working with increased ventilation.  Photo
Documentation
Required Sub-indicators:
a. Number of seats to be occupied must  Classroom Set up
not exceed the required number of based on max no.
maximum learners in the classroom of learners
 Classroom Set Up
 b. Seats to be occupied must be at least  Classroom Set Up
1-2 meters apart
c. Presence of markers and stickers on  Floor/Hallway
the floor to manage traffic system Markers
and physical distancing inside the  Signages/Stickers
classroom
d. In non- air-conditioned spaces,  Open Windows
windows and doors are open and Doors
e. In air-conditioned spaces, install  Availability of
exhaust fans and HEPA filters Exhaust Fans
f. Regardless of the HVAC system, all  Availability of
classrooms must have working electric working Electric
fans except for schools with no Fans per
electricity classroom
Optional Sub-indicators:
a. In airconditioned spaces, schools  Availability of
install appropriate ventilation and CO2 Monitoring
CO2 monitoring devices to achieve an Devices
air change rate 6 to Air Change per
Hour (ACH)
b. In spaces designed to optimize the use  Availability of Air
of air-conditioning units, wherein Purifiers
ventilation is greatly recirculated or
access to outside air is not feasible,
filters such as high-efficiency
particulate air (HEPA) filtration air
purifiers are used to clean recirculated
air, provided that the unit is adequate
for the size of the room in which it is
installed.
IV. SCHOOL TRAFFIC MANAGEMENT
Main Indicator:  Availability of
1. The school has established safe thermal
entrance and exit, and crowd scanner/gun,
management measures for teachers, alcohol dispenser,
students, non-teaching personnel, and face mask in the
school visitors. triage area
Required Sub-indicators:
a. Availability of temperature thermal  Availability of
scanner or thermal gun at the thermal
entrance and/ or exit gates scanner/gun
b. Availability of hand sanitizer or alcohol  Availability of
dispenser at school gates hand sanitizer/
alcohol dispenser
c. Availability of surgical masks at  Availability of face
school entrance reserved for mask
symptomatic individuals
Optional Sub-indicator:
a. Established drop-off and pick-up  Drop-Off/Pick up
points that are clearly identified and points
marked
Main Indicator:  Availability of
2. The school has set up clear and easy- school map,
to-understand signages, preferably in markings,
signages and
local languages, and mechanisms to
traffic
strengthen observance of health management plan
protocols and protective measures.

a. Display of school map at the  School Map

entrance point indicating the location
of the classrooms
b. School traffic management plan and  Traffic
strategies are in place to ensure that management plan
physical distancing is observed
c. Hallway ground markings for walking  Hallway
direction guide Markings/
signages
a. Designation of spaces for queue in  Markings/
high traffic areas like restroom, signages
library, principal's office, etc.
d. Installation of signages and/ or  Markings/
ground markings in high traffic signages
areas like restrooms and
handwashing stations to ensure
physical distancing
e. For schools with visually impair ed  Markings/
learners and personnel, signages signages
must be in Braille
Optional Sub-indicators:

a. Designation of separate entrance and  Entrance and Exit

exit points in the school point/ signages
b. Designation of entrance and exit  Entrance and Exit
points in the classrooms point/ signages
V. PROTECTIVE MEASURES. HYGIENE
PRACTICES. AND SAFETY PROCEDURES

Main Indicator:  Contact Tracing

1. The school has established contact Log sheet
tracing procedures for all those who  Health
enter the school premises {e.g., Declaration Form
learners, teachers, parents/
guardians, school personnel, etc.)
Main Indicator:  School COVID-19
2. The school has mobilized the School DRRM Team
COVID-19 DRRM team to ensure  With Roles and
Responsibilities
effective implementation of the
 Designations
school’s health and safety protocols
that are in place and are observed
during the preparation and
progressive expansion of face-to-face
classes.

Required Sub-indicators:  Designation of the

a. Designation of a Safety Officer Safety Officer/s
who serves as the focal person signed by the SH
for the health and safety
protocols of the school

Main Indicator:  PPEs:

3. The school has ensured the  Face Masks,
availability of personal protective Alcohol,
equipment (PPEs) and hygiene & Sanitizers,
Disinfectants
sanitation items for learners and school
personnel.

Required Sub-indicators
a. Availability of surgical face mask  Face Mask
b) Availability of antibacterial soap  Anti-Bacterial
Soap
c) Availability of emergency health  Emergency Health
kits that include PPEs and other Kits
 needed supplies and materials
in the school clinic
Main Indicator:  Hand washing
4. The school has set up and ensured facilities located
availability of proper sanitation and at the entrance
and other areas
hygiene facilities following the basic
inside the school
requirements and standard in
accordance with DO 10 s. 2016
Policy and Guidelines for the
Comprehensive Water, Sanitation
and Hygiene in Schools (WINS)
Program.

Required Sub-indicators:
a. Availability of handwashing station/  Handwashing
s with clean and safe water supply facility with water
and antibacterial soap supply, soap and
signages
b. Availability of clean and safe toilet  Functional Toilets
facilities with water
c. Placement of handwashing facilities  Handwashing
in strategic locations facilities in
different areas of
the school
d. Placement of trash bins in strategic  Trash bins in
locations every school
building
e. Display of visual signages on  Signages on waste
proper waste management management
practices near trash bins (e.g.
biodegradable, non-biodegradable,
recyclable)
f. Display of visual signages on  Signages on
proper handwashing in proper
handwashing handwashing
Main Indicator:
5. The school has ensured regular  Schedule of
sanitation and disinfection of school Disinfection/
facilities, furniture, and equipment. Photo
Documentation
Required Sub-indicators: 
a. Schedule of sanitation of frequently  Schedule of
touched surfaces (e.g., table, Disinfection/
doorknobs, light switches, etc.)  Photo
every after end of a school shift Documentation
b. Schedule of disinfection of school  Schedule of
facilities (e.g., chairs, desk, Disinfection/
blackboard, toilet facilities)  Photo
Documentation
c. Availability of sanitation and  Sanitation and
disinfecting materials Disinfection
materials
Main Indicator:  Disposal
6. The school has ensured a system/process/p
proper disposal system of roprotor of Used
PPEs
infectious wastes, such as
used tissues and masks, in
non-contact receptacles.
Required Sub-indicators:
a. Availability of a separate leak-proof  Leak proof trash
trash bag/ container with a cover bag or container
proper, l a b e l e d as "USED PPE"
for dis posal of all used PPE. In case
of unavailability of yellow trash
 bag/ container, a separate bag/
container marked for infectious
medical waste identifiable by the
waste collector (yellow ribbon, yellow
colored tag) should be available for
dispoal of all used PPE.
b. Collection of the leak-proof trash  Schedule of
bag/ container regularly or twice a Collection of Used
day (after end of class and after PPEs/
working day) from the designated/  System of School
Disposal
specific area to the general
collection area for treatment and
disposal
c. Availability of medical-grade face  Availability
mask required for school personnel Medical Grade
when collecting/handling the leak- Face Mask
proof trash bag/ container
d. Treatment through disinfection or  Disinfection
spraying of the collected wastes with a System/Process/
chlorine solution (1:10) in Protocol
accordance with DOH Department
Memorandum No. 20 2 0 -0 15 7
"Guide lines on Cleaning and
Disinfection in Various Settings as an
Infection Prevention and Control
Measure Against COVID-1 9"
e. Disposal of the disinfected PPEs  Disposal System
with general waste to the final of Used PPEs
disposal facility
VI. COMMUNICATION STRATEGY 
Main Indicator:  Communication
1. The school has developed a Plan (With flow
communication plan. chart and detailed
procedure)
Required Sub-indicators: 
a. Identification of platform of  Identify what
communication for coordination specific platform
purposes among the learners, (messenger,
parents / guardians, and teachers call/txt, et.,)
b. Database of contact number and  Data Base of
address of parents/guardians of Contact Numbers
the learners is kept for easy of
retrieval of their contact details in Parents/Guardian
s
case their child shows flu-like
symptoms while in the school
premises.
Posting of child -friendly Information,  Child Friendly
Education and Communication (IEC) Posters, signages,
materials on hygiene practices and markers related to
respiratory etiquette including COVID-19 health
protocols
hand hygiene (hand disinfection
thru handwashing and/or use of
70% isopropyl alcohol), respiratory
hygiene and cough etiquette
(coughing or sneezing into tissues
or one's elbow), protective measures
(proper use of face mask, ensuring
physical distancing) , among
others, that are placed in common
areas and available in local
languages and braille (if applicable)
Main Indicator:
2. The school has prepared an  Photo
Documentation
 orientation session for learners,
parents, guardians, teaching and  Minutes of the
non-teaching personnel, external Meeting
stakeholders, and LGU on the
eligibility criteria for participation and
existing protocols, mechanisms, and
procedures needed in the conduct of
the face-to-face classes.

Required Sub-indicators:

a. Orientation materials are made  Orientation

available for distribution to Materials/ IEC
teachers, learners, parents, BLGU, Materials such as
brochures, flyers,
DRRM team members, and persons-
leaflets
in-charge in ensuring observance
of protocols, mechanisms, and
procedures
Main Indicator:  COVID-19 Hotline
(updated) posted
3. The school has a proactive COVID-19 in different areas
inside the school
local hotline/help desk or any similar
site
local mechanism that connects and
coordinates to the hospitals, testing
facilities, and LGUs.
II. CONTINGENCY PLAN
Main Indicator:
1. The school has prepared a  Contingency Plan
contingency plan for suspension
and resumption of classes in case  (which includes
strategies on class
of COVID-19 resurgence in the suspension and
community. The contingency plan resumption and
includes the following: decision points)
• Decision points for school
suspension;
• Plans for the continuous
implementation of distance
learning modalities during
suspension; and
• Strategies for the resumption of
face-to-face classes after the
suspension
Main Indicator:  Contingency Plan
2. The school has developed
strategies for the continuity of
learning in the event of face-t o-
face class suspension due to
COVID-19 resurgence until local
authorities have determined the
safe resumption of face-to-face
classes.

Required Sub-indicators:
a. Distance learning modalities in  Distance Learning
the event of a class suspension Modality in case
due to COVID - 19 resurgence is of class
suspension shall
included in the contingency plan
be embedded on
the Contingency
Plan
FOCUSING ON TEACHING AND
LEARNING
I. LEARNING RESOURCES
 Main Indicator:  Inventory of
1. The school has secured Learning Material
sufficient supply of learning (SLMs, Textbooks
etc.,)
resources needed for the face-t o-
face classes.

Required Sub-indicators:
a. Avail ability of Self-Learning Modules  Inventory of SLMs
(SLMs) in the event of a class suspension
due to COVID-19 resurgence
b. Availability of Textbooks and other  Inventory of
Learning Resources Textbooks
c. Availability of Weekly Learning Plan  Weekly Learning
(WLP) Plan (Approved by
the SH and PSDS)
Optional Sub-indicator:
a. Provision of microphones or other  Availability of
appropriate sound system for microphones and
teachers to facilitate teaching in other assistive
a physical -distanced setup audio devices

II. FACE-TO-FACE CLASSES

Main Indicator:
1. The school has designed class  Class Program per
program/s that cater both learners Grade level
(approved by the
of the face-to-face class
SH and PSDS)
arrangement and distance
education while observing the
maximum 6-hour classroom
teaching hours of teachers.

Required Indicator:
a. Arrival, breaks, and dismissal time  Class Program
are staggered to avoid crowding of
learners in the school premises.

Main Indicator:  Class Program

2. The school has developed a teaching
schedule that follows the minimum
contact time for teaching and
learning. Minimum Contact
Grade Level
/ Teaching Time
Kindergarten 4 hours
and Grade 1
Grade 2 to 5 hours
Grade 12

**Schools are given flexibility in contact time/

teaching time for teaching and Learning
Main Indicator:  Weekly Learning
3. The school has ensured that learning Plan/ Class
remediation/intervention is part of the Program
regular class schedule and daily
teaching time, for a minimum of one
hour depending upon the needs of the
learners. Learning
remediation/intervention can be done
with learners individually or by small
group
Main Indicator:  Class Room Set
4. The school has ensured that the class up based on the
size is in accordance with the following required
maximum no. of
standards:
learners (Ocular
• Maximum of 12 learners for inspection)
Kindergarten;
• For Grades 1 to 12, the number of
learners in a classroom shall take
into consideration the varying
classroom sizes and required one-
meter physical distancing; and
• Maximum of 12 learners at a time
for those activities requiring the use
of workshops and laboratories.
Main Indicator: 
5. The school has comprehensively  Learners Profile
profiled learners who participate in
the progressive expansion of the face-
to-face classes such as but not limited
to the following:

a. Learners who reside within the  Learners Profile

city/municipality where the school/
learning center is located
b. Learners who can walk to school, or  Learners Profile
ride with available private transport
or with regulated public
transportation
c. Learners without existing  Learners Profile
comorbidities
d. For learners with existing  Learners Profile
comorbidities but may want to
participate in the face-to-face
classes, written consent from the
parents/ guardians must be secured
e. While vaccination of learners is  Learners Profile
encouraged, all learners may
participate in face-to-face classes
regardless of COVID-19 vaccination
status
f. Prioritization of learners who  Learners Profile
cannot manage independent
learning, such as those whose
parents must work outside the
home, or who do not have directly
available and immediately
responsible adults/ guardians at
home
g. Prioritization of learners who  Learners Profile
struggle to meet required learning
competencies
h. Prioritization of learners who are  Learners Profile
documented to be affected by
mental health concerns that may
be eased by face-to-face
interactions
III.TEACHER SUPPORT
Main Indicator:  Weekly Learning
1. The school has provided an Plan
appropriate learning and
development support plan in the
delivery of better-quality basic
education services.
 Required Sub-indicators:

a. Provision of School-Based  Weekly Learning

Learning Action Cells (LAC) Plan/Class
sessions to ensure that the Program
ability of teachers to deliver
relevant teaching and learning
strategies and ensure continuity
of learning through a
combination of distance
learning and face-to-face
classes
b. Coaching, mentoring, and  Minutes of the
training relevant in facilitating Meeting
blended learning approach  Documentation of
Coaching/training
Main Indicator: 
2. The school has oriented teachers on  Minutes of the
their budget of work and ensured Meeting
that the school requirement for the  Photo
Documentation of
learners is in observance of the Orientation
academic ease.
Required Sub-indicators:
a. Orientation on the  Minutes of the
implementation of the Most Meeting
Essential Learning Competencies  Photo
(MELCs) included in their budget of Documentation of
the Orientation
work during the face-to-face
classes
b. Orientation on the observance of
academic ease and provision of
flexibility to learners in
managing face-to-face classes
WELL-BEING AND PROTECTION
I. SCHOOL DISINFECTION AND
SANITATION
Main Indicator:  Sanitation and
1. The school has ensured that the Disinfection
available sanitation and disinfection Supplies/Material
materials are approved by the s
Philippine Food and Drug
Administration (FDA)
Main Indicator:  Sanitation and
2. The school has ensured the Disinfection
availability of sanitation and Supplies/Material
s (located in
disinfection materials are placed
various areas of
in strategic school locations. the school)
Required Sub-indicators:
a. Availability of  Hand sanitizers,
hand-sanitizers/alcohol-based alcohol and
solutions/ other disinfectants in disinfectants
restrooms
 Inventory of
b. Availability of hand-sanitizers/ supplies
alcohol-based solutions/ other
disinfectants in classroom
c. Availability of hand-sanitizers/
alcohol-based solutions/ other
disinfectants in entrance/exit point
II. COVID-19 CASE MANAGEMENT
Main Indicator:  Hand washing
1. The school has developed strategies facilities
to prevent COVID-19 which covers  Triage area
the following:  Thermal scanner

 Strategy to ensure all school-  Hand washing

goers are subjected to hand facilities at the
hygiene entrance and in
various areas of
the school
 Temperature checks using a  Thermal scanner
thermal scanner, whenever
applicable
 Non-face-to-face communications  Implementation of
and coordination through other Non-Face to face
available platforms to be prioritized platform of
communications
among school visitors and external
stakeholders. If face-to-face
communication is necessary, and
appointment scheduling
mechanism for authorized visitors
must be used/ enforced
 Daily rapid health checks in the  Daily Rapid
classroom Health Check
Plan/Schedule
 Photo
Documentation
 Developed a mechanism to  School
disinfect areas of the school Disinfection Plan
frequented by personnel or  Photo
learners who test positive for Documentation
COVID-19
 Availability of surgical face mask  Surgical Face
for anyone who shows symptoms Mask
of COVID-19
 Establishment/setting-up/  School Clinic
refurbishment of a school clinic (separate from
to provide basic health services Isolation Area)
to all school-goers
 Designation of private screening  School Clinic
area at the entrance where
school-goers who show symptoms
upon initial screening can be
further examined or referred
 Designation of separate space  Isolation Area
where sick school-goers who have (refurbished or
been managed in the clinic can makeshift room in
case of shortage
temporarily stay, awaiting referral
in facilities)
to the appropriate health facility,
without creating stigma
 Availability of a school health  Designated clinic
personnel or a designated school teacher/school
clinic teacher to provide basic health coordinator
health services and facilitate
 Approved
referral in coordination with the
designation by the
school health personnel at SDO, SH
in absence of school-based
health personnel
 For schools without a school  Photo
health personnel, orientation to Documentation
the clinic teacher by the school during
Orientation/TA
health personnel at the SDO for
proper guidance on how to
effectively run the school clinic
 Record of students' health status  Learners Profile
 and development, including
immunization checks to prevent  Immunization
outbreak-prone vaccine Records
preventable disease (e. g.,
measles)
Main Indicator:  Thermal Scanner
2. The school has identified
strategies to detect COVID-19  Contact Tracing
which include the following: Log Sheet

 School COVID-19
screening and
detection/flow
chart
 Consistent with DOH guidelines,  Communication
developed a coordination Plan
mechanism with local health
authorities in the event that  Referral System
tracing and quarantine will be
needed due to a confirmed case of
COVID- 19
 Presence of the School DRRM  School DRRM
Team to ensure that contact Team
tracing activities, as required by
the local health authorities, are  Organizational
Chart
initiated
 Roles and
Responsibilities
 Close coordination with  Communication
Epidemiology Surveillance Plan
Unit (ESU) officers per
setting  Referral System
 Development of a reporting  Communication
system requiring parents to Plan
report to the school if their
children are experiencing flu-like
symptoms, recommendation of
testing to be done immediately
with support and guidance from
the LGUs
 Provision of health form to  Parents’ Consent
parents/ guardians at the
beginning of each school term  Health
confirming their child and/or Declaration
family members do not have
COVID - 19 before being permitted
to go to school to be submitted 24
to 72 hours prior to the start of
school opening
Main Indicator:
3. The school has developed  School Isolation
strategies to isolate and manage Protocol/Mechani
COVID-19 which include the sm/Flowchart
following:
• Designation of rooms for  Isolation
isolation of students and Room/area
personnel with fever and flu-like
symptoms near the entrances
• Availability of transport vehicles  Transport vehicle
from school to Temporary (to be provided by
Treatment and Monitoring the school or
Community)
Facility (TTMF)
• Database of contact details of  Data Base of
the family members/guardians Parents/Guardian
 of the learners and personnel for s Contact Details
notification in case of symptoms
related to COVID-19
• Isolation and referral  Communication
mechanisms for personnel/ s or Plan
learner/ s who show COVID-19
symptoms based on the severity  Referral System
for proper management and
appropriate testing
• Reporting mechanism for  Contact Tracing
following-up and monitoring of all Procedure
close contacts as well as suspect,
probable, and confirmed cases of  Flow Chart of
Contact Tracing
COVID-19
 Referral system
Optional Sub-indicator:
a. Availability of QR codes and/or  QR Codes/IT
IT-based contact tracing system/ Based Contact
applications Tracing
Tools/system
Main Indicator:
4. The school has ensured availability  Documentation of
and maintained the provision of the provision of
Psychological
basic mental health and
First Aid activities
psychosocial support, as well as to learners and
guidance and counselling services to personnel
learners, teachers, and personnel
for the entire school year.
Required Sub-indicators:
a. Availability of guidance advocates  Designated
in every school day to assist Guidance
learners and personnel in Counselor
accessing basic mental health
 Approved
services
Designation by
the SH
b. Mobilization of trained  Documentation of
Psychological First Aid (PFA) the provision of
providers to offer necessary Psychological
First Aid and
mental health and psychosocial
other Mental
support to concerned personnel or Health Services
learners during crisis situations
c. Allocation of the first hour of the  Documentation of
first five school days for the the provision of
discussion and facilitation of the Psychological
First Aid and
modules related to mental health,
other Mental
by the respective classroom advisers Health Services
or designated teachers.
 Class Program

 Weekly Learning
Plan
d. Establishment and  Referral System
contextualization of inter-sectoral
referral pathways to ensure that  Communication
Plan
psychosocial needs of both the
personnel and the learners are
provided. Psychosocial concerns
involving children shall be
coordinated with DOH, DSWD and
other key agencies and
organizations as necessary to
better address the concern
 e. Engagement of parents, guardians,  Documentation
or any care providers of learners on
taking care of mental health and  Minutes of the
Meeting
creating a positive environment
f. Establishment of coordination  Referral System
mechanisms to ensure that the
mental health and the basic  Communication
Plan
needs of learners and personnel
with pre-existing mental health
conditions and special needs
Main Indicator:  Referral System
5. The school has established a
clear procedure of referral  Communication
Plan
system for COVID-19 confirmed
and suspected personnel and
learners.
Required Sub-indicator:
a. Communication plan which  Referral System
includes coordination system
and referral with LGU for  Communication
Plan
confirmed and suspected
COVID-19 cases in the school
Main Indicator:  Contact Tracing
6. The school has established a Procedure/ Flow
clear contact tracing and Chart
quarantine system for close
 Referral System
contacts of COVID-19
confirmed positive cases.  Communication
Plan
Required Sub-indicators:
a. Communication plan which includes  Communication
coordination system with local health Plan
authorities in contact tracing and
quarantine of close contacts of
confirmed COVID-19 positive cases
b. Communication plan which includes  Communication
notification of family/ parent(s) / Plan
guardian(s) of the concerned learner/
s  Data Base of
Contact Details of
Parents/Guardian
s
III. INCLUDING THE MOST
MARGINALIZED
Main Indicator:  Learners Profile
1. The school has established a
mechanism in identifying learners who
are most vulnerable and disadvantaged
in terms of access to learning.
Main Indicator:  Weekly Learning
2. The school has developed learning Plan
strategies to cater the needs of the
marginalized learners, such as
modules in Braille, mother-tongue
languages, and usage of Filipino Sign
Languages
Main Indicator:  Weekly Learning
3. The school has ensured participation Plan
in school-based services
 Class Program
Main Indicator: 
4. The school has established close
coordination with the Department of
 Social Welfare and Development  Referral System
(DSWD) Case Managers of those
learners who are marginalized; other  Communication
partner agencies and organizations Plan
such as National Council on
Disability Affairs NCDA.
SCHOOL COMMUNITY 
COORDINATION
Main Indicator:  Communication/
1. The school has developed a Coordination Plan
plan for the coordination with the
 Referral System
Barangay Local Government Unit
(BLGU) or the Barangay Health
Emergency Response Team
(BHERT) in ensuring that protocols
are observed properly.

Required Sub-indicator:
a. Operationalization of the  School PASS
Preventative Alert System in Implementation
Schools (PASS) for CO VID - 19 Plan/Mechanism
(per DepEd Memorandum No.
15 s. 2020)
Optional Sub-indicator:
a. The school has identified a  Waiting Area for
designated waiting area with Parents/Guardian
proper ventilation and strict s
observation of physical distancing
for parents/ guardians /
chaperones

Main Indicator:  Communication/

2. The school has coordinated Coordination Plan
with their respective local
government units the
implementation of routine
school-based immunization
(SBI) and other school health-
related services, such as but not
limited to deworming and weekly
iron-folate acid
supplementation (WIFA).
Main Indicator:  Communication/
3. In collaboration with their local Coordination Plan
health offices, the school has
developed intensive health  Advocacy
campaign
promotion campaign activities /
materials
supportive-policies to maintain optimal
health seeking behaviors of learners
and other community members.
TO BE FILLED OUT BY THE SDO
COMPOSITE TEAM
1. The school has secured the  Barangay Letter of
concurrence of the Local Chief Support
Executive in the City/Municipality
where the school is located and must  LGU Letter of
Support/SB
also have taken the proper
Resolution
coordination with their respective
barangay officials.

a. For schools in IP communities or with a  FPIC

predominant number of IP learners, the Documentation
 Free, Prior, and Informed Consent  Certificate of
(FPIC) process must be undertaken Precondition from
according to the customary NCIP
practice of the IP community. The
cultural expression of consent and
sealing of agreements shall be
documented, with the permission of the
community and in a form acceptable to
them (e.g. pictures, videos). Without
prejudice to the latter, a Certificate of
Precondition issued by NCIP shall also
attest to the undertaking of the FPIC
process and agreements reached
2. The school has secured written  Parents
consent from the parents / guardians Consent/Permit
of learners who will participate in the
face-t o -fa c e classes.
Total No. of Learners: Male ___
Female___
No. of Participating Learners for the
Expanded Face-to-Face: Male _____ Female ___
3. Vaccination Status of School
Personnel
No. of Vaccinated Teachers: Male___
Female ___
Total No. of Teachers: Male___ Female ___
No. of Vaccinated Non-Teach in g Personnel:
Male __ Female __

Total No. of Vaccinated Non-Teaching

Personnel: Male ___ Female

Verified by:

Name and Designation Date