Republic of the Philippines

Department of Education
REGION VI – WESTERN VISAYAS
SCHOOLS DIVISION OF ILOILO
Diday Elementary School
Brgy. Diday, Miagao, Iloilo

CLASSROOM DAILY HEALTH MONITORING TOOL FOR COVID-19

Level: ___________________
Direction: Write under each column date the code(s) of the symptoms observed in the learner during the routine inspection, during the conduct of the class
or as infected by the learner or their classmate. Refer to the lit of symptoms below in their respective code:
F – Fever ST – Sore Throat LoA – Lost of Appetite D – Diarrhea F/T – Fatigue / Tiredness R – Rashes
C – Cough HA – Headache N – Nausea LoS – Lost of Smell C/RN - Runny Nose Others:
___________________

Symptoms Observed / Reported

Name Date: Date: Date: Date: Date:
  Monday Tuesday Wednesday Thursday Friday
1            
2            
3            
4            
5            
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13            
 14            
15            
16            
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 treatment by the school clinic teacher or health personnel.

Submitted by: Noted:

___________________________________ ________________________________________
Class Adviser Clinic Teacher