ANNEX E: COVID-19 MONITORING TOOLS

Tool Description
Para sa mga Magulang For distribution to parents of learners who will report to school; may be part of the parent's consent that
they will sign in approving learner's physical reporting to school

Notice to Reporting Personnel For display at the entrance gate and/or for distribution to reporting personnel (may be signed at least once)

Visitor's Declaration Form For visitors who will enter the school; to be accomplished by the visitor and assessed properly by designated
school staff prior to approval of entry (there must be guidelines as to when visitors may be accommodated
and for what identified purposes)

Teacher's Record For teachers to keep per class, each day, during health routine inspection (teacher may be provided with step-
by- step instruction on how to facilitate the inspection using the tool)

Logsheet For safekeeping at the Clinic c/o the Clinic Teacher/Nurse to record all cases managed at the Clinic

School Head's Summary The school head shall keep a summary of the health status of learners and personnel, especially those who
will manifest COVID-19 symptoms for proper monitoring and identification of necessary next steps
 Symptoms Translation/Description
01 Fever Lagnat/ang body temperature ay 37.5 C o higit pa
02 Cough Ubo
03 General weakness Panghihina ng katawan
04 Fatigue/Tiredness Pagkapagod
05 Headache Pananakit ng ulo
06 Muscle/joint/body pains Pananakit ng katawan, kalamnan, kasu-kasuan
07 Sore throat Pananakit o pamamaga ng lalamunan
08 Colds/runny nose Sipon
09 Difficulty of breathing Pagkahapo o hirap sa paghinga
10 Loss of appetite Kawalan ng ganang kumain
11 Nausea Nasusuka
12 Vomiting Pagsusuka
13 Diarrhea Pagtatae
14 Loss of smell Pagkawala ng pang-amoy
15 Loss of taste Pagkawala ng panlasa
Rashes
16 Mga butlig sa balat; pamumula ng balat (maaaring makati o hindi)
Others
17 Mga sintomas o obserbasyon sa pangangatawan o pagkilos ng tao/bata na kailangan ng atensyong
medikal
 Paalala sa mga
Magulang/Guardian

Kung ang inyong anak po o ang sinuman sa inyong sambahayan ay kasalukuyang nakararanas o
nakaranas sa nakalipas na 14 na araw ng alinman sa mga sumusunod na sintomas, mangyari pong
huwag na munang papasukin ang bata sa eskwela.

Huwag din po munang papasukin sa eskwelahan ang inyong anak kung siya o ang sinuman sa inyong
sambahayan ay nagpositibo sa COVID-19, naging close contact ng COVID-19 case, o nadiagnose sa
pneumonia.

Ipagbigay alam po agad ang sitwasyon sa kanilang guro na si G/Gng/Bb. _, sa

numero bilang _, upang maisaayos ang alternative delivery mode para sa
kanilang pag-aaral habang sila ay nasa bahay.

Mangyari pong imonitor ang kondisyon ng inyong anak o kasama sa bahay, at iulat sa inyong
Barangay Health Emergency Response Team (BHERT), Barangay Health Station, o Rural Health Unit,
kung kinakailangan, upang sila ay mabigyan ng kaukulang lunas.
Ipinapabatid din po ng pamunuan ng _ na imomonitor po
ng kanilang mga guro ang mga mag-aaral na pumapasok sa paaralan at ipagbibigay-alam agad
sa inyo at sa mga kinauukulan kung sila ay ma-obserbahan o maiulat na nakakaranas ng alinman
sa
mga sintomas na nabanggit sa itaas.

Mangyari pong itago o idisplay sa inyong bahay ang paalalang ito upang magsilbing gabay para sa
 Notice to Reporting
Personnel
By proceeding to report to school today, you guarantee the school management that neither you nor
any member of your household experiences any of the following symptoms:

You also confirm that neither you nor any member of your houshold is currently tagged as COVID-19
positive or a close contact of a COVID-19 positive case, or has been diagnosed with pneumonia.

If you experience any of the abovelisted symptoms while you are in school, kindly report immediately
to the School Clinic for appropriate assessment and/or referral as needed.
 Health Declaration Form

Source: COMELEC (Note: Ask DOH of standard declaration form, and appropriate action per
reported information [e.g., do not allow entry if they checked "yes" to any statement?], if
available.)
 CLASSROOM DAILY HEALTH MONITORING TOOL FOR COVID-19

Grade Level: Section:

Instruction: Write under each column date the code(s) of the symptom(s) observed in the learner during the routine inspection, during the conduct of the class, or as
reported by the learner or their classmates. Refer to the list of symptoms below and their 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 Others

Symptoms Observed/Reported
NAME 2021-09-13 2021-09-14 2021-09-15 2021-09-16 2021-09-17
Monday Tuesday Wednesday Thursday Friday

Note: 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 management by the School Clinic Teacher or health personnel.

Submitted by: Noted by:

Classroom Adviser Clinic Teacher

 Procedure for Reporting, Management, and Referral
Person Activities Means of Verification Resources Needed
Note: In case of life-threatening emergency, bring the learner to the nearest health facility as soon as possible, while informing the parent of the situation. Necessary first
aid must be provided until the learner is attended by the medical personnel in the facility.
Classroom teacher Performs initial/basic Daily Health Monitoring Tool for Thermometer, printed health
Step 1 asssessment of the condition of COVID-19 monitoring tool (1 sheet per week per
the learner (either through class)
(Option 1) Classroom teacher Sends text message to the Clinic Mobile phone with load
Step 2a Teacher informing them about
the symptomatic learner
(Option 1) Clinic assistant Fetches the symptomatic learner Clinic assistant
Step 2b from the classroom to the clinic
(Option 2) Classroom assistant Accompanies the symptomatic Classroom assistant
Step 2 learner to the clinic
Step 3a Clinic teacher/nurse Logs the information of the Logsheet (Name, reported
Clinic teacher/nurse Assesses condition of the learner
Step 3b
(Verify the symptoms)
Clinic teacher/nurse Provides first aid treatment and Referral Slip Referral Slip
initiates necessary preparations
Emergency Step 4
for sending the learner to the
nearest health facility (e.g.,
Clinic teacher/nurse Contacts the DepEd Medical Mobile phone with load; contact
Officer or the MHO/RHU doctor information of the Medical Officer
Step 4a (in case there is no DepEd assigned for the school and of the
Medical Officer) MHO/RHU doctor; ensure
DepEd Medical Provides instruction to the clinic Logsheet (Doctor's order); Mobile phone with load (access to
Officer/MHO/RHU doctor teacher (which may include Photo/Soft copy of messenger/viber);
Step 4b reporting to the BHERT or Prescription/Instruction Slip (Sent Prescription/Instruction Slip
sending to the nearest hospital through Messenger/Viber)
facility as needed, based on the
Clinic teacher/nurse Contacts the parent about the Logsheet (Remarks; that parent was ~Mobile phone with load; contact information
condition of the learner if notified and informed about the of the parent
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s health (e.g., text d r
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s h medications, age) o a lis e r
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Step 4b.ii (As needed) Clinic teacher/nurse Makes f n o )
necessary preparations
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 Provides first aid treatment as Medicines to address symptoms;
instructed by the Medical first aid kit; other equipment (non-
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Officer contact thermometer, pulse
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t oximeter, nebulizer, forceps, BP
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h apparatus, oxygen tank, sterilizer);
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1 (Refer to list of equipment that
must be present in the
(Option 1) Clinic assistant Accompanies the learner back to
Step 6 the classroom once cleared
(Option 2) Classroom assistant Fetches the learner from the
Step 6 clinic to the classroom once
Path 2a (If parent is asked to fetch the child; from 4bi)
Step 6 Parent Arrives in the
school to fetch the Logbook (Remarks); "May MGH Slip, including list of
Clinic teacher/nurse Provides Go Home"/MGH Slip (with reminders/instructions for
instruction/im copy signed by the parent, the parent (including what to
portant to be left to the Guard and monitor; need to report to
information to then returned to the Clinic) BHERT as needed; need to
the parent inform school if the learner
Step 7 tests

Clinic teacher/nurse Follows-up on Logsheet (Follow-up status) Mobile phone

Step 8 the condition with load; contact
of the learner, information of
including
results of the parent
The School Head, together with the clinic teacher, is expected to prepare a summary of reported/managed/referred learners, and their condition.
Path 2b (For COVID cases; if learner is referred to BHERT; from 4biii)
Classroom Receives information Parent's consent form
Ste teacher/clinic from BHERT/parent must include a provision
p teacher/nurse that the learner(s) that parents are required
9a is/are positive for to report to the school the
Classroom COVID-19 COVID-19 test
teacher/clinic Informs the school
Ste teacher/nurse head about the
p case(s)
9b

School head
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i School head Informs and
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m head Follows-up on the condition of the close contacts,
a including
t Reminders:
e
s 1. Medical certificate/clearance may be required before learners are allowed to return to face-to-face classes, subject to the approval of the DepEd
Medical Officer.
a
n 2. There must be avaible alternate clinic teachers/nurses to take over the management of the clinic in case the first batch of clinic
d teachers/nurses become close contacts of a positive case or test positive for COVID-19.
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Date Time Name Age Sex Grade Teacher Adviser Chief Complaint(s) Doctor's Order Treatment Administered By Remarks Follow-up Status
Admitted & [Reason(s) for the clinic [To be initialed by the Medical Officer [Indicate how the instructions of the doctor were [As needed; Date/Status]
Section visit/reported symptom(s)] upon visit]/ Supported by the followed, as well as other actions taken; e.g., ordered to _Adm
doctor's Prescription/Instruction Slip return to classroom, what time; reported to BHERT, Para
iniste ceta
specify contact number; informed the parent about r
instructions, fetched by; etc.] mol
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 SUMMARY OF HEALTH STATUS OF PERSONNEL AND LEARNERS For the Month of:

School Name Grade Level/Section Date Reported Action COVID-19

Category S Taken Status per
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MAY GO HOME SLIP

Date:
Name
Age
Sex
Grade/Section
Teacher-Adviser

This certifies that the learner has been provided initial management at the clinic, with instructions from:
Name of Doctor:

The doctor has given instruction that the learner may go home/be fetched by his/her parent/guardian.

Signed:

Clinic Teacher/Nurse

This certifies that I have been provided important information/instructions by the clinic teacher/nurse:

Signed:

Name of fetcher:
Relation to the child:
Time fetched:

Present this May Go Home Slip and cut and leave the upper portion of the slip to the guard before leaving the school.

This lower portion may be brought home by the parent/fetcher.

REMINDERS TO THE PARENT

_ Please monitor the following:

_ Please consult with…

_ Your child has been reported to the BHERT ( ); please coordinate with them for the next steps
_ Please inform the school immediately if your child tests positive for COVID-19.
_ Medical certificate/clearance is required before the learner is allowed to return to face-to-face classes, subject
to the approval of the DepEd Medical Officer.

Other instructions:
<Address>

<Name of Doctor>
<Position>
List of symptoms (per DOH DM 2020-0512)
PMA