Republic of the Philippines

Department of Education
Caraga Region
SCHOOLS DIVISION OF AGUSAN DEL NORTE
NASIPIT NORTHWEST DISTRICT
MINBAHANDI ELEMENTARY SCHOOL
Nasipit, Agusan del Norte

CLASSROOM DAILY HEALTH MONITORING TOOL FOR COVID-19

S.Y. 2021-2022

Write under each column the codes of the symptoms observed in the learner during the routine inspection, during the conduct of class or as reported by the learners
on their classmates. Refer to the list of symptoms below and the 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 Nausea LoS Loss of Smell O Others

Grade and Section: GRADE V- FALCATA

MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY

Name of Pupils Date:________ Date:________ Date:________ Date:________ Date:________
MALE SYMPTOMS TEMP SYMPTOMS TEMP SYMPTOMS TEMP SYMPTOMS TEMP SYMPTOMS TEMP
1. AMBONGAN, JERAM A.
2. BANDIBAS, JONELITO L.
3. CASIRES, JESRAEL M.
4. CUGIHAN, EKTORYAM T.
5. GUMIHAY, RANDE M.
6. LAMBONAO, SHERBERT A.
7. PONGGAOTAN, BENJOMAR L.
8. TALJA, DINES M.
 MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY
Name of Pupils Date:________ Date:________ Date:________ Date:________ Date:________
FEMALE SYMPTOMS TEMP SYMPTOMS TEMP SYMPTOMS TEMP SYMPTOMS TEMP SYMPTOMS TEMP
1. AGUHAR, TRISHIA MAE L.
2. AYUBAN, YELENA E.
3. BINONGKASAN, GILBA M.
4. LIGAYNA, JERNALYNM.
5. LIGAYNA, KIMBERLY T.
6. MANDAHINOG, MARA M.
7. MANSACUBAN, BEM-BEM E.
8. PINABIGOL, SAMER L.
9. TALJA, ANALYN T.
10. TALJA, LAILYN S.
11. TUMANAN, MONELYN T.

Prepared by: Noted by:

SHIELA MAE P. YONSON GRACE M. CENIZA

Class Adviser School Principal-I