OFFICE OF THE VICE PRESIDENT FOR OPERATIONS

WEEKLY CONTACT TRACING FORM

INSTRUCTION: This form shall be submitted as a requirement for report to work every Monday or on the first work day of the week. You may indicate a
brief description of your health remarks and activity remarks if you do not find an applicable code below. For the transport remarks, indicate the type of vehicle
used as applicable.

NAME DEPARTMENT:
JERICK C. SUBAD JUNIOR HIGH SCHOOL DEPARTMENT

DAYS DATE & TEMP. HEALTH ACTIVITY REMARKS TRANSPORT

TIME IN CHECK REMARKS REMARKS
EGRESS
(Indicate all that apply) ACTIVITY / TRANSACTION
CODE
USE CODE

MONDAY

TUESDAY

WEDNESDAY

THURSDAY

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FRIDAYrrf

SATURDAY

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SUNDAY

HEALTH CODE: EGRESS CODE:

A – Normal A – GSC Annex
B – Fever (37.8˚ or highers B – Bank
) C – Fast food
C – Cough D – Mall, Grocery, Supermarket
D – Sore Throat E – Payment and Remittance Centers
E – Difficulty of Breathing F – Internet and Telecom (Globe, Smart, Sun Cellular, PLDT)
F – Body/Muscle Pain G – CELCOR, CCWD, NEECO
G – Diarrhea H – Drugstore, Hospital
H – Colds/Runny Nose