Republic of the Philippines

Department of Education
Region X
LANAO DEL NORTE DIVISION
Pigcarangan, Tubod, Lanao del Norte

EXPANSION OF THE LIMITED FACE-TO-FACE CLASSES

Monitoring Tool
Name of School: __________________________ Total No. of Learners: ____________
Name of Principal: __________________________ Total No. of Teachers:_________
School ID: __________ Total No. of Non-Teaching Personnel:______
NOT
STATEMENT OBSERVED REMARKS
OBSERVED
1 The principal is fully vaccinated.
2 All teachers are fully vaccinated.
3 With 100% compliance of parent's consent of the learners.
4 With Mayor's Permit
5 With Barangay Clearance/ Permit
6 Entrance gate of the school (Triage)
*Temperature checking of the learners
*Temperature checking of the teachers
*Temperature checking of the visitors
*Observed proper wearing face mask
* Fill-up health declaration form
* Logbook near the entrance gate with temperature record.
7 COVID-19 Health & Safety Protocol
Compliance of Minimum Health Standards ( Observed proper
wearing of face mask and maintain physical distancing)
Presence of functional Thermal Scanner to check all school
entrants
With authomatic Alcohol dispenser.

Availability of Information Education , Communication (IEC)

materials (Proper Handwashing, Proper Wearing of face mask,
maintaining physical distancing and sneezing/coughing or
resperatory etiquette)
8 Access to Handwashing Facilities
*The school have enough handwashing facilities to enable
handwashing for all learners , teachers, and other staff
a) School entrance (or exit)
b) Toilets (Funtional Gendered Toilet)
c) School Canteen
*With available water for cleaning and regular hand washing.
a) from source on school premises
b) with support of parents and community
* The supply of soap enough to allow each students and staff to
wash their hands at least 5 times a day.
*With Group Handwashing Facility with functional faucets.
9 Regular Cleaning/Disinfection and Waste Management in the
school campus

*Waste management system in place to ensure trash bins are

emptied on daily basis. (with supporting school memo issued to
ensure transh bins are emptied on daily basis)
 * With segragated waste bins with cover (following the color
coding) are available in classrooms, toilets, and playground.

*The school have enough manpower to ensure daily cleaning and

disinfecting of toilets, classrooms, offices and high touch surface
(door handles, railing, etc) are done according to standard. (with
supporting school memo issued to ensure daily cleaning and
disinfecting toilets and classrooms with the assigned manpower)
*The school have a management system in place using checklist for
cleaning and disinfection.
a. Toilets
b. Classroom
c. Offices
d. Frequently touched surface (e.g. door handles, railing, etc.)

*The school have enough supply of the following materials to

ensure daily cleaning and disinfecting of toilets and frequently
touched surfaces in accordance with standards:
a) detergent
b) bleach (sodium hypochlorite)
c) sponges
d) toilet brush
e) dipper and bucket (for flushing)
f) gloves and face mask (for cleaners)
10 Classroom structuring/Physical Arrangement in Schools
*All classrooms must have proper ventilation
*Windows are open

*Classrooms follow physical layout for physical distancing (as

Enclosure of DepED-DOH Joint Memorandum Circular No. 1, s.
2021)
11 Preventive Alert System

The school ensures the Operationalization of the Preventive Alert

System in Schools (PASS) for COVID-19 per DepEd Memorandum
No. 15, s.2020/ Presence of School Contingency Plan for Face-to-
Face
The school ensures learners have personal hygiene kit (hand
12 sanitizer and face mask).
Formulated school policy on strict wearing of face mask according
13 to Required Health Standards of DepEd
The schools have an establish linkage with the health sector at
14 community level for updates and contract tracing.
The schools have a monitoring team or focal person to ensure that
15 the protocols are regularly followed.

16 Compliance with standards to SSAT (School Safety Assessment

Tool) - Enclosure No. 1 to DepEd Memorandum No. 071, s. 2021
GENERAL OBSERVATION/S:

DATE: _____________
MONITORING TEAM:
_____________________________________ ___________________________________
SIGNATURE OVER PRINTED NAME SIGNATURE OVER PRINTED NAME
_____________________________________ ___________________________________
SIGNATURE OVER PRINTED NAME SIGNATURE OVER PRINTED NAME
 _____________________________________ ___________________________________
SIGNATURE OVER PRINTED NAME SIGNATURE OVER PRINTED NAME
_____________________________________ ___________________________________
SIGNATURE OVER PRINTED NAME SIGNATURE OVER PRINTED NAME

SIGNATURE OVER PRINTED NAME OF SCHOOL HEAD