Republic of the Philippines

CENTRAL LUZON CENTER FOR HEALTH DEVELOPMENT

DEPARTMENT OF HEALTH
City of San Fernando, Pampanga
www.ro3.doh.gov.ph

DENGUE MONITORING TOOL FOR SCHOOLS

Province TARLAC
Municipality/City CONCEPCION
Barangay STA. MARIA E/S
Name of School STA. MARIA ELEMENTARY SCHOOL
(no abbreviations)
Name of Principal DIORELLA BERNADETTE D. SICAT
Name Interviewed
Date Monitored
No. of enrolled students 203 No. of 4 No. of Administrative 4
for present school year Classrooms Rooms
Name of assigned Health Provider/s in school
(MD, DMD, PHN, or other para medicals)
(Instruction: Check if YES or NO and indicate narrative under comments)
YES NO Comments
1. School Environment
1.1 Is Long Lasting NO (State year of installation; indicate no. of rooms with LLITC vs Total
number of rooms; state the general condition of LLITC if installed as to
Insecticide Treated whether there is a need to replace or repair)
Curtain (LLITC)
installed in the NEED REPLACEMENT
classrooms?
1.2 Is/are there breeding NO (State whether breeding site is found inside the room, within school
premises, or within school perimeter; state the container or item/object
site/s for mosquitos? identified as breeding site)

1.3 Is use of ovi-traps still NO (State the condition of ovi-traps if still being implemented; state how data
from this strategy is interpreted)
implemented? NO AVAILABLE OVI TRAP. NEED NEW SUPPLIES

2. Status of Dengue Prevention and Control

2.1 Is there a mechanism to Y (State activities conducted and dates on when were these activities
conducted within the year related to dengue advocacy; state if there are
include information localized advocacy materials and/or videos utilized)
dissemination for
dengue prevention and 4 O’CLOCK HABIT, BRIGADA KALINISAN.
control (ex. 4 o’ clock SCHOOL ORIENTATION ABOUT DENGUE
habit, 4S Strategy TOGETHER WITH THE STAKEHOLDERS.
against dengue)?

Tel no. (045) 861-3425 to 29 / 861-3701 / 455-3297, Email address: doh_chd3@yahoo.com

“ISO tayo…Serbisyongdekalidad at siguraDOH”
DOH-CLCHD-LHSD-SOP-01-00
Form9Rev.0
 Republic of the Philippines

CENTRAL LUZON CENTER FOR HEALTH DEVELOPMENT

DEPARTMENT OF HEALTH
City of San Fernando, Pampanga
www.ro3.doh.gov.ph

2.2 Are streamers, posters, Y

tarpaulins or other IEC
materials
available/posted?
2.3 Is there a school clinic? Y
2.4 Is schedule of school Y BY SCHEDULE
nurse’s duties/school
physician’s visits
present and posted?
2.5 Is daily “Fever Y (State if there is a tool or logbook used for recording and reporting; state
also how the febrile cases are attended and referred and the regularity of
Screening” for students submission of reports)
being implemented?
NONE

2.6 Are there medicines Y (State medicines available) PARACETAMOL SYRUPS AND
TABLETS FOR PRIMARY AND INTERMEDIATE.
available to manage
fever?
2.7 Is there a referral Y (Describe the implemented referral system)
REFER TO THE RHU OR DISTRICT HOSPITAL IF STUDENTS
process being HAS A HIGH FEVER ESPECIALLY THE DENGVAXIA
implemented for RECIPIENTS FOR NS 1.
suspected dengue case?
2.8 Is there a presence of Y
directory of nearest
health facilities?
2.9 Is there a functional N (Please request for a copy of issued memorandum with the names of the
Dengue Watch Student Brigade members; how frequent do they meet)
Dengue Watch Student
Birgade?

2.10 Is daily 4 o’ clock Y (Please request for a copy of documentation or report)

habit conducted?
2.11 Is there daily Y BY ADVISORSHIP

inspection of
classrooms for possible
breeding sites?
2.12 Are there other Y (State these methods/measures)
ORIENTATION AND REGULAR REMINDERS FOR STUDENTS
methods/ measures AND OTHER STAKEHOLDERS.
implemented related to
anti-dengue campaign
performed?

Tel no. (045) 861-3425 to 29 / 861-3701 / 455-3297, Email address: doh_chd3@yahoo.com

“ISO tayo…Serbisyongdekalidad at siguraDOH”
DOH-CLCHD-LHSD-SOP-01-00
Form9Rev.0
 Republic of the Philippines

CENTRAL LUZON CENTER FOR HEALTH DEVELOPMENT

DEPARTMENT OF HEALTH
City of San Fernando, Pampanga
www.ro3.doh.gov.ph

Monitored by (Printed Name over Signature)

Designation

Place of Assignment

Tel no. (045) 861-3425 to 29 / 861-3701 / 455-3297, Email address: doh_chd3@yahoo.com

“ISO tayo…Serbisyongdekalidad at siguraDOH”
DOH-CLCHD-LHSD-SOP-01-00
Form9Rev.0