Annex C

CLASSROOM DAILY HEALTH MONITORING TOOL FOR COVID-19

Grade Level: Kinder Section: MT. MAYON (A.M.)

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 DB Difficulty of breathing A Absent Others (Please specify)

F/T Fatigue/Tiredness C/RN Colds/runny nose EN Essentially Normal
ST Sore throat R Rashes LoT Loss of taste
LoA Loss of appetite D Diarrhea LoS Loss of smell
C Cough HA Headache N Nausea
GW General weakness MJBP Muscle/joint/body pains Vm Vomiting

Symptoms Observed/Reported
NAME Date Date 2022-08-22 2022-08-25 Date
Monday Tuesday Wednesday Thursday Friday
MALE
1. Amper, Joricho M. EN EN EN EN
2. Bacus, Zed Yhuan H. EN EN EN EN
3. Capunan, Kyle Andrie B. EN EN EN EN
4. Castro, Rj Davnor P. EN EN EN EN
5. Cavan, Kurt R. EN EN EN EN
6. Dy, Christopher Luke M. EN EN EN EN
7. Gabaton, Junlou R. EN EN EN EN
8. Gara, Daryl Than M. EN EN EN EN
9. Guhao, Austin Jay C. EN EN EN EN
10. Lapinosa, Jhunrey D. EN EN EN EN
11. Manguilimotan, Aaron P. EN EN EN EN
12. Pizarra, Vince Zenen B. EN EN EN EN
13. Sanipal, Chrest Lorence S. EN EN EN EN
14. Sarmiento, Angelo- EN EN EN EN
15. Segaril, Marvin Nathan A. EN EN EN EN
FEMALE
1. Amaranto, Rich P. EN EN EN EN
2. Cardo, Angel J. EN EN EN EN
3. Dumacon, Jea EN EN EN EN
4. Fortunado, Krysthel N. EN EN EN EN
5. Jorolan, Ashly Heart A. EN EN EN EN
6. Noynay, Scarlett V. EN EN EN EN
7. Rio, Crisha Pauline G. EN EN EN EN
8. Rodel, Bless Angel Q. EN EN EN EN
9. Sembrano, Carla Luiza A. EN EN EN EN

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:
MONA LIZA S. LUCEÑO LIEZEL P. CABALLERO
Classroom Adviser Clinic Teacher

Grade Level: VI Section: AGILA

Annex C
CLASSROOM DAILY HEALTH MONITORING TOOL FOR COVID-19

Grade Level: Kinder Section: MT. MAYON (P.M.)

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 DB Difficulty of breathing A Absent Others (Please specify)

F/T Fatigue/Tiredness C/RN Colds/runny nose EN Essentially Normal
ST Sore throat R Rashes LoT Loss of taste
LoA Loss of appetite D Diarrhea LoS Loss of smell
C Cough HA Headache N Nausea
GW General weakness MJBP Muscle/joint/body pains Vm Vomiting
 Symptoms Observed/Reported
NAME Date Date 2022-08-22 2022-08-25 Date
Monday Tuesday Wednesday Thursday Friday
MALE
1. Abella, Prince Anthony B. EN EN EN EN
2. Abo, Dean S. EN EN EN EN
3. Abo, Peter S. EN EN EN EN
4. Baugbog, Ashton Grey B. EN EN EN EN
5. Belarmino, John Clent
6. Casing, Axl Jhon M. EN EN EN EN
7. Emano, James Jay B. EN EN EN EN
8. Lumantas, Jesus Jovani C. EN EN EN EN
9. Medrina, Mark Daniel O. EN EN EN EN
10. Oliverio, Julie Jay G. EN EN EN EN
11. Peligro, Angelou C. EN EN EN EN
12. Quiruela, Juan Miguel S. EN EN EN EN
13. Rivas, Rean Mark C. EN EN EN EN
14. Rosco, Jacob S. EN EN EN EN
FEMALE
1. Angana, Princess D. EN EN EN EN
2. Baticura, Frankincense M. EN EN EN EN
3. Dulla, Rey-Ian M. EN EN EN EN
4. Dupitas, Lyn Anthonette P. EN EN EN EN
5. Harapan, Novie Kyle A. EN EN EN EN
6. Libawan, Jesabel A. EN EN EN EN
7. Rivas, Richel Jane M. EN EN EN EN
8. Seneca, Jai C. EN EN EN EN
9. Ybañez, Chrishane M. EN EN EN EN

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:
MONA LIZA S. LUCEÑO LIEZEL P. CABALLERO
Classroom Adviser Clinic Teacher
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 DB Difficulty of breathing A Absent Others (Please specify)
F/T Fatigue/Tiredness C/RN Colds/runny nose EN Essentially Normal
ST Sore throat R Rashes LoT Loss of taste
LoA Loss of appetite D Diarrhea LoS Loss of smell
C Cough HA Headache N Nausea
GW General weakness MJBP Muscle/joint/body pains Vm Vomiting
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 DB Difficulty of breathing A Absent Others (Please specify)
F/T Fatigue/Tiredness C/RN Colds/runny nose EN Essentially Normal
ST Sore throat R Rashes LoT Loss of taste
LoA Loss of appetite D Diarrhea LoS Loss of smell
C Cough HA Headache N Nausea
GW General weakness MJBP Muscle/joint/body pains Vm Vomiting
Annex D
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.)
Annex B
WEEKLY SUMMARY OF HEALTH STATUS OF VISITORS
Inclusive Dates: May 23-27, 2022
School GREDU ELEMENTARY SCHOOL

Name Date of Visit/s Purpose of Visit Date Reported Symptom(s) Action Taken
Observed/Reported (Referred to)
(Please Enumerate ALL)

NONE NONE NONE NONE NONE NONE

NONE NONE NONE NONE NONE NONE
NONE NONE NONE NONE NONE NONE
NONE NONE NONE NONE NONE NONE
NONE NONE NONE NONE NONE NONE
NONE NONE NONE NONE NONE NONE
NONE NONE NONE NONE NONE NONE
NONE NONE NONE NONE NONE NONE
NONE NONE NONE NONE NONE NONE
NONE NONE NONE NONE NONE NONE
NONE NONE NONE NONE NONE NONE
NONE NONE NONE NONE NONE NONE
NONE NONE NONE NONE NONE NONE

Prepared by: Noted:

LIEZEL P. CABALLERO LEONORA D. CAŇETE

Clinic Teacher/Nurse School Head
COVID-19 Status per Follow-Up
(Positive/Negative)

NONE
NONE
NONE
NONE
NONE
NONE
NONE
NONE
NONE
NONE
NONE
NONE
NONE
Annex A
WEEKLY SUMMARY OF HEALTH STATUS OF PERSONNEL AND LEARNERS
Inclusive Dates: MAY 23-27, 2022
School

Name Category Grade Level/ Section Date Reported Symptom(s) Action Taken
(Personnel/Learner) Observed/Reported (Referred to)
POSTRERO, CLAISA L. Teacher KINDER/MT. TAAL N/A ESSENTIALLY NORMAL NONE
AMARANTO, APRIL P. Teacher KINDER/MT. APO N/A ESSENTIALLY NORMAL NONE
LUCEñO, MONA LIZA S. Teacher KINDER/MT. MAYON N/A ESSENTIALLY NORMAL NONE
MAGALLON, JELLA N. Teacher KINDER/ MT.PINATUBO N/A ESSENTIALLY NORMAL NONE
APARICI, NILDA R. Teacher KINDER/MT. ARAYAT N/A ESSENTIALLY NORMAL NONE
GERALDO, GLORIA B. Teacher GRADE 1/LILY N/A ESSENTIALLY NORMAL NONE
PONTILAR, LORINA J. Teacher GRADE 1/ADELFA N/A ESSENTIALLY NORMAL NONE
IGANO, MA. RIZALYN H. Teacher GRADE 1/ROSAL N/A ESSENTIALLY NORMAL NONE
MONES, NIEVA S. Teacher GRADE 1/ORCHID N/A ESSENTIALLY NORMAL NONE
ZUNIEGA, BERNADITA P. Teacher GRADE 1/DAISY N/A ESSENTIALLY NORMAL NONE
APOYA, DELMA P. Teacher GRADE 2 /APITONG N/A ESSENTIALLY NORMAL NONE
ALCORDO, ELENA A. Teacher GRADE 2 /MAHOGANY N/A ESSENTIALLY NORMAL NONE
FIGUEROA, ALICE B. Teacher GRADE 2 /MOLAVE N/A ESSENTIALLY NORMAL NONE
PONFERRADA, LORINDA G. Teacher GRADE 2 /LAWAAN N/A ESSENTIALLY NORMAL NONE
BENIGNO, CARMELITA M. Teacher GRADE 2 /YAKAL N/A ESSENTIALLY NORMAL NONE
VELORIA, RINA R. Teacher GRADE 3/JACINTO N/A ESSENTIALLY NORMAL NONE
MONTERO, ELIZABETH C. Teacher GRADE 3/SILANG N/A ESSENTIALLY NORMAL NONE
NACARIO, FREDILINE B. Teacher GRADE 3/LUNA N/A ESSENTIALLY NORMAL NONE
ABRIGANA, JUDITH D. Teacher GRADE 3/BONIFACIO N/A ESSENTIALLY NORMAL NONE
MAG-ASO, MARY ANN C. Teacher GRADE 4/LANGKA N/A ESSENTIALLY NORMAL NONE
ARCAMO, RODGIE MAY A. Teacher GRADE 4/ATIS N/A ESSENTIALLY NORMAL NONE
TORION, LIEZL L. Teacher GRADE 4/MELON N/A ESSENTIALLY NORMAL NONE
VITO, LOURDES B. Teacher GRADE 4/DURIAN N/A ESSENTIALLY NORMAL NONE
REGALADO, MARIVEL A. Teacher GRADE 5/RAMOS N/A ESSENTIALLY NORMAL NONE
BAGGAY, MARIA LEONORA H. Teacher GRADE 5/AQUINO N/A ESSENTIALLY NORMAL NONE
CAMPOSO, JENEIVEVE A. Teacher GRADE 5/ROXAS N/A ESSENTIALLY NORMAL NONE
DUCADO, EVANGELINE T. Teacher GRADE 5/LAUREL N/A ESSENTIALLY NORMAL NONE
REPATO, ELRAGILDINO A. Teacher GRADE 5/QUEZON N/A ESSENTIALLY NORMAL NONE
FUENTES, MICHELLE F. Teacher GRADE 6/KALAPATI N/A ESSENTIALLY NORMAL NONE
RAMOS, CHERRY MAY A. Teacher GRADE 6/KALAW N/A ESSENTIALLY NORMAL NONE
CABALLERO, LIEZEL P. Teacher GRADE 6/LORO N/A ESSENTIALLY NORMAL NONE
MILLADA, JOEMER R. Teacher GRADE 6 N/A ESSENTIALLY NORMAL NONE
CALONIA, MARCIHU B. Teacher GRADE 6/AGILA N/A ESSENTIALLY NORMAL NONE
RAPISORA, DINAH S. Teacher GRADE 6/LAWIN N/A ESSENTIALLY NORMAL NONE
CAYAMBA, ALEXIS K. Teacher GRADE 6 N/A ESSENTIALLY NORMAL NONE
MADRESTA, AL-DIO D. AO-II NONE N/A ESSENTIALLY NORMAL NONE
CAÑETE, LEONORA D. Principal NONE N/A ESSENTIALLY NORMAL NONE

LIEZEL P. CABALLERO LEONORA D. CAŇETE

Clinic Teacher/Nurse School Head
COVID-19 Status per Follow-Up
(Positive/Negative)
NEGATIVE
NEGATIVE
NEGATIVE
NEGATIVE
NEGATIVE
NEGATIVE
NEGATIVE
NEGATIVE
NEGATIVE
NEGATIVE
NEGATIVE
NEGATIVE
NEGATIVE
NEGATIVE
NEGATIVE
NEGATIVE
NEGATIVE
NEGATIVE
NEGATIVE
NEGATIVE
NEGATIVE
NEGATIVE
NEGATIVE
NEGATIVE
NEGATIVE
NEGATIVE
NEGATIVE
NEGATIVE
NEGATIVE
NEGATIVE
NEGATIVE
NEGATIVE
NEGATIVE
NEGATIVE
NEGATIVE
NEGATIVE
NEGATIVE
Annex C
CLASSROOM DAILY HEALTH MONITORING TOOL FOR COVID-19

Grade Level: KINDER Section: Mt. Mayon

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 DB Difficulty of breathing A Absent Others (Please specify)

F/T Fatigue/Tiredness C/RN Colds/runny nose EN Essentially Normal
ST Sore throat R Rashes LoT Loss of taste
LoA Loss of appetite D Diarrhea LoS Loss of smell
C Cough HA Headache N Nausea
GW General weakness MJBP Muscle/joint/body pains Vm Vomiting

Symptoms Observed/Reported
NAME 5/23/2022 5/24/2022 Date Date
Monday Tuesday Wednesday Thursday
1. Acol, Kaeddie Kobe M. EN EN
2. Brigoli, Arleo Davidson P. A A
2. De Asis, Louie Jhan D. EN EN
4. Sabido, Laurence P. EN EN
5. Veloria, John Jorenz R. EN EN
6. Codoy, Bella Diane S. EN EN
7. Diana, Amber Brianna L. EN EN
8. Lapasaran, Kendra Joana M. EN EN
9. Lobo, Maria Adelfa Joy C. EN EN
10. Pantalita, Jannah C. EN EN
11. Tabudlong, Princess, Harra R. EN EN
12. Trimidal, Chloe Cristal Maiden B. EN EN
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:

MONA LIZA S. LUCEŇO LIEZEL P. CABALLERO
Classroom Adviser Clinic Teacher

CLASSROOM DAILY HEALTH MONITORING TOOL FOR COVID-19

Grade Level: KINDER Section: MT. PINATUBO

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 DB Difficulty of breathing A Absent Others (Please specify)

F/T Fatigue/Tiredness C/RN Colds/runny nose EN Essentially Normal
ST Sore throat R Rashes LoT Loss of taste
LoA Loss of appetite D Diarrhea LoS Loss of smell
C Cough HA Headache N Nausea
GW General weakness MJBP Muscle/joint/body pains Vm Vomiting

Symptoms Observed/Reported
NAME 5/23/2022 5/24/2022 Date Date
Monday Tuesday Wednesday Thursday
1. Baclaan, Reynardz - EN EN
2. Baron, Khristian Lemuel U. EN EN
3. Hermitanio, Joshua L. EN EN
4. Manulat, Jhon Mark R. EN EN
5. Marcos, Edrean A. EN EN
6. Marcos, Edner Mark, A. EN EN
7. Virtudazo, Lourd John L. EN EN
8. Bongcawil, Vivian May D. EN EN
9. Café, Angel Mae A. EN EN
10. Cortez, Shyra Mae Nicol - EN EN
11. Jimeno, Aprill Jhane M. EN EN
12. Elesio, Cherry Mae V. EN EN

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:
JELLA N. MAGALLON LIEZEL P. CABALLERO
Classroom Adviser Clinic Teacher

CLASSROOM DAILY HEALTH MONITORING TOOL FOR COVID-19

Grade Level: KINDER Section: MT.ARAYAT

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 DB Difficulty of breathing A Absent Others (Please specify)
F/T Fatigue/Tiredness C/RN Colds/runny nose EN Essentially Normal
ST Sore throat R Rashes LoT Loss of taste
LoA Loss of appetite D Diarrhea LoS Loss of smell
C Cough HA Headache N Nausea
GW General weakness MJBP Muscle/joint/body pains Vm Vomiting

Symptoms Observed/Reported
NAME 5/23/2022 5/24/2022 Date Date
Monday Tuesday Wednesday Thursday
1.Borja, Jhonsen K. EN EN
2.Intong, Prince Jhon H. EN EN
3.Marco, Ethan Dave C. EN EN
4.Nara, Stingrey H. EN EN
5.Sible, Argie EN EN
6.Tiongson, Zionshen L. EN A
7.Aguilar, Eden Rose EN EN
8.Dumaghan, Rhea Mae G. EN EN
9.Gerondio, Merabella V. EN EN
10.Lomocso, Kamiya EN EN
11.Lumantas, Shantal Grace T. EN EN
12.Pormanis, Kimberlie P. EN EN
13.Ramada, Nathalia Jane D. EN EN

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:
NILDA R. APARICI LIEZEL P. CABALLERO
Classroom Adviser Clinic Teacher

CLASSROOM DAILY HEALTH MONITORING TOOL FOR COVID-19

Grade Level: KINDER Section: MT. TAAL

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 DB Difficulty of breathing A Absent Others (Please specify)

F/T Fatigue/Tiredness C/RN Colds/runny nose EN Essentially Normal
ST Sore throat R Rashes LoT Loss of taste
LoA Loss of appetite D Diarrhea LoS Loss of smell
C Cough HA Headache N Nausea
GW General weakness MJBP Muscle/joint/body pains Vm Vomiting

Symptoms Observed/Reported
NAME 5/16/2022 5/17/2022 Date Date
Monday Tuesday Wednesday Thursday
1.BANDIALA, BRENT MATTHEW SALANGO EN EN
2.CORONEL, NATHANIEL SANCHEZ EN EN
3.DELA CRUZ, ABJUN MASAMAYOR EN EN
4.HANOYAN, JOHN LEJAY EN EN
5.NARAGA, MICO JAY SANCHEZ A EN
6.VILLADOLID, KEAN HARLEY APIADO EN A
7.BELARMINO, YOHAN MAE UGAY EN EN
8.DOLON, MIKAELA CAMBONGGA EN EN
9.LIBRERO, ANGEL MAE TEJAMO EN EN
10.LOPEZ, CLOUIE SUMCIO EN EN
11.MATURAN, ZAMANTHA CLAIRE ESCOSAR A A

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:
CLAISA L. POSTRERO LIEZEL P. CABALLERO
Classroom Adviser Clinic Teacher

CLASSROOM DAILY HEALTH MONITORING TOOL FOR COVID-19

Grade Level: KINDER Section: MT.APO

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 DB Difficulty of breathing A Absent Others (Please specify)
F/T Fatigue/Tiredness C/RN Colds/runny nose EN Essentially Normal
ST Sore throat R Rashes LoT Loss of taste
LoA Loss of appetite D Diarrhea LoS Loss of smell
C Cough HA Headache N Nausea
GW General weakness MJBP Muscle/joint/body pains Vm Vomiting
 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 DB Difficulty of breathing A Absent Others (Please specify)

F/T Fatigue/Tiredness C/RN Colds/runny nose EN Essentially Normal
ST Sore throat R Rashes LoT Loss of taste
LoA Loss of appetite D Diarrhea LoS Loss of smell
C Cough HA Headache N Nausea
GW General weakness MJBP Muscle/joint/body pains Vm Vomiting

Symptoms Observed/Reported
NAME 5/23/2022 5/24/2022 Date Date
Monday Tuesday Wednesday Thursday
1.ARGUILLES, JERRICK - EN EN
2.BUSTAMANTE, JOEL DUAZO EN EN
3.DARAMAN, REIVYN BELMORES EN EN
4.FLORES, KHENZOE DUMANHOG EN EN
5.GA-AS, BENZ MOUR CUPAS EN EN
6.LINTUAN, AJ KENT PUYAT EN EN
7.PAYOT, AERO WILLIAM ANDRES EN EN
8.TADLE, GREG ABANES EN EN
9.GONZALES, KRISTINE KATE NAYRE EN EN
10.GUIMBARDA, JULIAN - EN EN
11.LOZADA, ASHNA GRASIA EN EN
12.PANTONIAL, KISSES RAGAS EN EN
13.SIMBAJON, MARJORIE CELIS EN EN

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:
APRIL P. AMARANTO LIEZEL P. CABALLERO
Classroom Adviser Clinic Teacher
 Date
Friday
ediately for the proper

Date
Friday
ediately for the proper

Date
Friday
ediately for the proper

Date
Friday
ediately for the proper
 Date
Friday

ediately for the proper

Annex C
CLASSROOM DAILY HEALTH MONITORING TOOL FOR COVID-19

Grade Level: I Section: ADELFA

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 DB Difficulty of breathing A Absent Others (Please specify)

F/T Fatigue/Tiredness C/RN Colds/runny nose EN Essentially Normal
ST Sore throat R Rashes LoT Loss of taste
LoA Loss of appetite D Diarrhea LoS Loss of smell
C Cough HA Headache N Nausea
GW General weakness MJBP Muscle/joint/body pains Vm Vomiting

Symptoms Observed/Reported
NAME 5/23/2022 5/24/2022 Date Date Date
Monday Tuesday Wednesday Thursday Friday
Ambingan, Darren B. EN EN
Bactol, Bryx Clydd G. EN EN
Cardama, Bryle Andrie S. EN EN
Huraño, Ben Joshua S. EN EN
Lago, Jeho B. EN A
Lago, Jeo B. EN EN
Montepolca, Rhian James EN EN
Polinio, Jasper S. EN EN
Tormis, Marl Alexis P. EN EN
Day- onan, Angeline A. A A
Gollodo, Alexa Zia C. EN EN
Ligero, Keziah Chen S. EN EN
Manulat, Sophie Claire V. EN EN
Montepolca, Thaniela Jan M. EN EN
Sangilan, Abigail S. EN EN
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:
LORINA J. PONTILAR LIEZEL P. CABALLERO
Classroom Adviser Clinic Teacher

CLASSROOM DAILY HEALTH MONITORING TOOL FOR COVID-19

Grade Level: I Section: LILY

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 DB Difficulty of breathing A Absent Others (Please specify

F/T Fatigue/Tiredness C/RN Colds/runny nose EN Essentially Normal
ST Sore throat R Rashes LoT Loss of taste
LoA Loss of appetite D Diarrhea LoS Loss of smell
C Cough HA Headache N Nausea
GW General weakness MJBP Muscle/joint/body pains Vm Vomiting

Symptoms Observed/Reported
NAME 5/23/2022 5/24/2022 Date Date Date
Monday Tuesday Wednesday Thursday Friday
1. COLIS, PAUL RYAN B. EN EN
2. ALMIROL, ALTHEA AKIESHA C. EN EN
3. GUMERA, KINT ZANDER H. A EN
4. SAUSE, LHEONA MIE R. EN EN
5. AGUILAR, RHYLIE JUDIEL EN EN
6. BALAT, JADE CELINE B. EN EN
7. LABANDERO, RAYMOND D. EN EN
8. BACUS, MHAICA H. EN EN
9. LABARES, GABRIEL EN EN
10. PANTON, ALTHEA MARIE EN EN
11. MENDOZA, KEN JAMES EN EN
12. TATING, JAH RUSSEL EN A
13. TERESO, JOSEPH A EN
14. MONTEFALCON, ZHAC ERON EN EN

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:
GLORIA B. GERALDO LIEZEL P. CABALLERO
Classroom Adviser Clinic Teacher

CLASSROOM DAILY HEALTH MONITORING TOOL FOR COVID-19

Grade Level: I Section: DAISY

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 DB Difficulty of breathing A Absent Others (Please specify)
F/T Fatigue/Tiredness C/RN Colds/runny nose EN Essentially Normal
ST Sore throat R Rashes LoT Loss of taste
LoA Loss of appetite D Diarrhea LoS Loss of smell
C Cough HA Headache N Nausea
GW General weakness MJBP Muscle/joint/body pains Vm Vomiting

Symptoms Observed/Reported
NAME 5/23/2022 5/24/2022 Date Date Date
Monday Tuesday Wednesday Thursday Friday
LEGASPINO,NATHAN EN EN
ANAJAO,JIN MATTHEW O. EN EN
MARTINEZ,CYRILL JOHN T. EN EN
DIVINAGRACIA,LIAM JAY M. EN A
CUBELO,FRANCIS MAHCRAGE E. EN A
LUMANTAS,MARK JOHN T. EN EN
JUNIOSA,LOISSE KIEFFER A. EN EN
MALALIS.SKY D. EN EN
CAL,SCARLETTE HEART EN EN
MABANTA,ANGEL CHEDELLE A. EN EN
SALINAS,MARMAE E. EN EN
ALDERITE ERICKHA S. EN EN
ALGUZAR,CRISTINE JANE C. EN EN
BARQUILLA,JASMINE EN A
TADLE,YSABELLE A EN EN

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:
BERNADITA P. ZUNIEGA LIEZEL P. CABALLERO
Classroom Adviser Clinic Teacher

CLASSROOM DAILY HEALTH MONITORING TOOL FOR COVID-19

Grade Level: I Section: ROSAL

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 DB Difficulty of breathing A Absent Others (Please specify)
F/T Fatigue/Tiredness C/RN Colds/runny nose EN Essentially Normal
ST Sore throat R Rashes LoT Loss of taste
LoA Loss of appetite D Diarrhea LoS Loss of smell
C Cough HA Headache N Nausea
GW General weakness MJBP Muscle/joint/body pains Vm Vomiting
 Symptoms Observed/Reported
NAME 5/23/2022 5/24/2022 Date Date Date
Monday Tuesday Wednesday Thursday Friday
AGUISANDO, NOE CHAN EN EN
CANOY, XINVE ISAAC EN EN
CAÑO, LAURENCE EN EN
DANTE, ELTEO JAY M. EN EN
EDUSMA, ALBERT JR. C EN EN
ESTRADA, JEHLAN P. EN EN
GALOPE, RAMIL JR. A A
PANTASTICO, SHON P. EN EN
SANIPAL, BARENCE A A
UMPAN, JOLIBERN L. A A
BUCTON, DIVINE INOUE R. EN EN
CASAS, VIVIAN B. EN EN
LAMOCHA, RONA RUBELLE EN EN
TAGUDIN, MARIA LAINE EMILY EN A
VELASCO, CHELSE LYKA C. EN EN

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:
MARIA RIZALYN H. IGANO LIEZEL P. CABALLERO
Classroom Adviser Clinic Teacher

CLASSROOM DAILY HEALTH MONITORING TOOL FOR COVID-19

Grade Level: I Section: ORCHID

 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 DB Difficulty of breathing A Absent Others (Please specify) en-
F/T Fatigue/Tiredness C/RN Colds/runny nose EN Essentially Normal
ST Sore throat R Rashes LoT Loss of taste
LoA Loss of appetite D Diarrhea LoS Loss of smell
C Cough HA Headache N Nausea
GW General weakness MJBP Muscle/joint/body pains Vm Vomiting

Symptoms Observed/Reported
NAME 5/23/2022 5/24/2022 Date Date Date
Monday Tuesday Wednesday Thursday Friday
1. BLAGANTIO, CHRISTIAN DAVE EN A
2. CASTRO, DALE JAMES D. EN A
3. GAMOTIN, COLLIN KLYDE EN A
4. MELORIN, RUSTOM JAY EN EN
5. SALUMAG, TOMMY M. EN EN
6. SUAZO, ALDRICH JAMES L. EN A
7. VILLAROJO, ASH EZEKIEL EN EN
8. VIRTUDAZO, MARK ANTOINNE A A
9. SABLAS, KLIO A A
10. ESTRADA, KEESHA A A
11. OMPAD, NATHALIE KATE EN A
12. MONTEJO, NYX ANCIELA EN EN
13. BELARMINO, LOUREY EN EN
14. LEOPARDAS, JOYLIN EN EN
15. DE GRACIA, CHENG JOYCE A A

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:
NIEVA S. MONES LIEZEL P. CABALLERO
Classroom Adviser Clinic Teacher
Annex C
CLASSROOM DAILY HEALTH MONITORING TOOL FOR COVID-19

Grade Level: II Section: MAHOGANY

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 DB Difficulty of breathing A Absent Others (Please specify)

F/T Fatigue/Tiredness C/RN Colds/runny nose EN Essentially Normal
ST Sore throat R Rashes LoT Loss of taste
LoA Loss of appetite D Diarrhea LoS Loss of smell
C Cough HA Headache N Nausea
GW General weakness MJBP Muscle/joint/body pains Vm Vomiting

Symptoms Observed/Reported
NAME 5/23/2022 5/24/2022 Date Date Date
Monday Tuesday Wednesday Thursday Friday
BAYLON, LOUIE JR. D. EN EN
DATILES, ZAC MATHEW EN EN
DE GRACIA, JOHN PAUL C C
DELA GENTE, MART DANRYL L. C/RN C/RN
ESCALERA, KURT U. EN EN
FLORENTINO, JOHN RILEY D. A EN
GEMENTIZA, ELVEN CLARK EN A
MOSQUEDA, RIO ANTON P. EN EN
PROFETA, RODVINCENT A. EN EN
TIDOY, SHAWN MARION EN EN
ATEJANO, KIM KAIZELLE C C
CORONEL, PRINCESS MAE A EN
VERDEFLOR, JAIDELL EN EN
LAPINOSA, ISABELLE A. A EN
IBITA, SHELOH EN EN
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:
ELENA A. ALCORDO LIEZEL P. CABALLERO
Classroom Adviser Clinic Teacher

CLASSROOM DAILY HEALTH MONITORING TOOL FOR COVID-19

Grade Level: II Section: APITONG

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 DB Difficulty of breathing A Absent Others (Please specify)

F/T Fatigue/Tiredness C/RN Colds/runny nose EN Essentially Normal
ST Sore throat R Rashes LoT Loss of taste
LoA Loss of appetite D Diarrhea LoS Loss of smell
C Cough HA Headache N Nausea
GW General weakness MJBP Muscle/joint/body pains Vm Vomiting

Symptoms Observed/Reported
NAME 5/23/2022 5/24/2022 Date Date Date
Monday Tuesday Wednesday Thursday Friday
ACOL, RENSELL C C
ALMODAL, HARWELL EN EN
ANAJAO, JAY LEJANDRO EN EN
CARAJAY, KYLERIX C C
FEROLINO, TRISTAN C C
GARCIA, MICHAEL JOHN EN EN
LOMOSCO, KEIANNE SASHI EN EN
MANGUILIMOTAN, ART A EN
MANULAT, JHON CARLOU EN EN
MILO, KIRBY EN EN
SAGAL, MC LEREY EN A
SALANTES, RENCE LYON EN EN
MILO, JOYLYN EN EN
NIÑO, AIHLEEN EN EN

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:
DELMA P. APOYA LIEZEL P. CABALLERO
Classroom Adviser Clinic Teacher

CLASSROOM DAILY HEALTH MONITORING TOOL FOR COVID-19

Grade Level: II Section: LAWAAN

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 DB Difficulty of breathing A Absent Others (Please specify)

F/T Fatigue/Tiredness C/RN Colds/runny nose EN Essentially Normal
ST Sore throat R Rashes LoT Loss of taste
LoA Loss of appetite D Diarrhea LoS Loss of smell
C Cough HA Headache N Nausea
GW General weakness MJBP Muscle/joint/body pains Vm Vomiting

Symptoms Observed/Reported
NAME 5/23/2022 5/24/2022 Date Date Date
Monday Tuesday Wednesday Thursday Friday
AGUIRRE, KICHAN COEY A A
ANGUY, JOHN MICHAEL A A
BRIONES, MATT JADEN EN EN
MORILLA, MHEKI EN EN
RAGAS, KEN MARK A A
REYES, SJASS EN EN
VILLACUAL, KIAN EN EN
BANDOY, SOFHIS AMOR EN EN
CAMILO, NAVEEN A A
CANDA, KLARISSE EN EN
DACALLOS, KYLA EN EN
OMPAD, CHRISTELLE MAE EN EN
SALUD, PRINCESS DIANNE EN A
VELASCO, CRISTAL JANE EN EN
GALON, ASHLEY JOY EN EN

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:
LORINDA G. PONFERRADA LIEZEL P. CABALLERO
Classroom Adviser Clinic Teacher

CLASSROOM DAILY HEALTH MONITORING TOOL FOR COVID-19

Grade Level: II Section: YAKAL

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 DB Difficulty of breathing A Absent Others (Please specify)

F/T Fatigue/Tiredness C/RN Colds/runny nose EN Essentially Normal
ST Sore throat R Rashes LoT Loss of taste
LoA Loss of appetite D Diarrhea LoS Loss of smell
C Cough HA Headache N Nausea
GW General weakness MJBP Muscle/joint/body pains Vm Vomiting

Symptoms Observed/Reported
NAME
 NAME 5/23/2022 5/24/2022 Date Date Date
Monday Tuesday Wednesday Thursday Friday
ANDOY JOHN KENNETH EN EN
DELAGENTE DAVE LOIUE EN EN
FLORES ,JAMES DEAN EN EN
LIBREA JACOB MARCO EN EN
VERDAD ,JOSHUA EN EN
VILLADOLID HANZ KENZO EN EN
BELARMINO , JILLIANNE EN EN
MILLANA ,LINDSAY EN EN
PANTASTICO, CARLY MAY EN EN
TUGA OB ,MERRY CHRIS EN EN
MONTON , HANNAH MAY EN EN
YOSORES ,ASHLEY EN EN
ROBIN ALEXANDRA EN EN

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:
CARMELITA M. BENIGNO LIEZEL P. CABALLERO
Classroom Adviser Clinic Teacher

CLASSROOM DAILY HEALTH MONITORING TOOL FOR COVID-19

Grade Level: II Section: MOLAVE

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 DB Difficulty of breathing A Absent Others (Please specify)
F/T Fatigue/Tiredness C/RN Colds/runny nose EN Essentially Normal
ST Sore throat R Rashes LoT Loss of taste
LoA Loss of appetite D Diarrhea LoS Loss of smell
C Cough HA Headache N Nausea
GW General weakness MJBP Muscle/joint/body pains Vm Vomiting
 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 DB Difficulty of breathing A Absent Others (Please specify)

F/T Fatigue/Tiredness C/RN Colds/runny nose EN Essentially Normal
ST Sore throat R Rashes LoT Loss of taste
LoA Loss of appetite D Diarrhea LoS Loss of smell
C Cough HA Headache N Nausea
GW General weakness MJBP Muscle/joint/body pains Vm Vomiting

Symptoms Observed/Reported
NAME 5/23/2022 5/24/2022 Date Date Date
Monday Tuesday Wednesday Thursday Friday
ABDULLAH, NASHER IDRIAN EN EN
CATBAGAN, BEJAMINE EN EN
SIMBAHON, CARL JOAN EN EN
PANES, XYRENCE EN EN
BLANCO, MYKO EN EN
CENA HANZ JHONZEL EN EN
AMBINGAN, REY MARKY EN EN
EMBODO, MITCH EN EN
MAIZA, FIONA EN EN
CASAS, SOFIA JEAN EN EN
LABADAN, HANNAH EN EN
POLINIO, ARYANA EN EN
SEVILLA, ALJEAN EN EN

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:
ALICE B. FIGUEROA LIEZEL P. CABALLERO
Classroom Adviser Clinic Teacher
Annex C
CLASSROOM DAILY HEALTH MONITORING TOOL FOR COVID-19

Grade Level: III Section: JACINTO

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 DB Difficulty of breathing A Absent Others (Please specify)

F/T Fatigue/Tiredness C/RN Colds/runny nose EN Essentially Normal
ST Sore throat R Rashes LoT Loss of taste
LoA Loss of appetite D Diarrhea LoS Loss of smell
C Cough HA Headache N Nausea
GW General weakness MJBP Muscle/joint/body pains Vm Vomiting

Symptoms Observed/Reported
NAME 5/23/2022 5/24/2022 Date Date Date
Monday Tuesday Wednesday Thursday Friday
1.Cequiña Anthone Dexter EN EN
2.Dumacon Jeffrey EN EN
3.Gementiza Lorraine EN A
4.Capio Daniel A EN
5.Salpocial Jayvee EN EN
6.Albindsa Precious May A A
7.Nara Lady Lyn A EN
8.Salpocial Jenice EN EN
9.Villas Mica EN EN
10.Villas Mikee EN EN
11.Vistal Christine Joy A A
12.Legaspino Audrey A EN
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:

RINA R. VELORIA LIEZEL P. CABALLERO
Classroom Adviser Clinic Teacher

CLASSROOM DAILY HEALTH MONITORING TOOL FOR COVID-19

Grade Level: III Section: BONIFACIO

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 DB Difficulty of breathing A Absent Others (Please specify)
F/T Fatigue/Tiredness C/RN Colds/runny nose EN Essentially Normal
ST Sore throat R Rashes LoT Loss of taste
LoA Loss of appetite D Diarrhea LoS Loss of smell
C Cough HA Headache N Nausea
GW General weakness MJBP Muscle/joint/body pains Vm Vomiting

Symptoms Observed/Reported
NAME 5/23/2022 5/24/2022 Date Date Date
Monday Tuesday Wednesday Thursday Friday
1.CERVANTES, ART KEVIN B. EN EN
2.DAMIAR, EREL VINCE D. A A
3.DIAGAN, MARK BONNIE S EN EN
4.FLORES, BRYAN EN EN
5.INDUS, JHONREY B. EN EN
6.LOFRANCO, HENRY JANE EN EN
7.PUNGAY, RYOU KEN P. A A
8.ALEJANDRO, CYRISH T. EN A
9.CUEVAS, RICHELLE C. EN EN
10.VELARDE, PRINCES MAE Q. EN EN
11.CAMACHO, JUSTINEVER S. EN EN
12.QUIBOL, SEDRICK JAMES- EN EN

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:
JUDITH D. ABRIGANA LIEZEL P. CABALLERO
Classroom Adviser Clinic Teacher

CLASSROOM DAILY HEALTH MONITORING TOOL FOR COVID-19

Grade Level: III Section: SILANG

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 DB Difficulty of breathing A Absent Others (Please specify)

F/T Fatigue/Tiredness C/RN Colds/runny nose EN Essentially Normal
ST Sore throat R Rashes LoT Loss of taste
LoA Loss of appetite D Diarrhea LoS Loss of smell
C Cough HA Headache N Nausea
GW General weakness MJBP Muscle/joint/body pains Vm Vomiting

Symptoms Observed/Reported
NAME 5/23/2022 5/24/2022 Date Date Date
Monday Tuesday Wednesday Thursday Friday
1. JERUIN O. BACLA-AN EN EN
2.JAN FELIP LUIS COLINARES EN EN
3.CHRIS ESCOBEDO EN EN
4.MA’IR GUIABAR EN EN
5.JAN RECA KEMENERO EN EN
6.ANGEL MAE LOZADA EN EN
7.EDEN MAE MARCOS A A
8.NATHAN JAKE RAMADA EN EN
9.HARVEY JHON REYES EN EN
10. MAE SALINAS EN EN
11.JESSICA SAMONTE EN EN
12.SHEENA MARIE PUNGAY EN EN
13.STEPHEN JHIEM VIRTUDAZO A A

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:
ELIZABETH C. MONTERO LIEZEL P. CABALLERO
Classroom Adviser Clinic Teacher

CLASSROOM DAILY HEALTH MONITORING TOOL FOR COVID-19

Grade Level: III Section: LUNA

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 DB Difficulty of breathing A Absent Others (Please specify)

F/T Fatigue/Tiredness C/RN Colds/runny nose EN Essentially Normal
ST Sore throat R Rashes LoT Loss of taste
LoA Loss of appetite D Diarrhea LoS Loss of smell
C Cough HA Headache N Nausea
GW General weakness MJBP Muscle/joint/body pains Vm Vomiting
 ST Sore throat R Rashes LoT Loss of taste
LoA Loss of appetite D Diarrhea LoS Loss of smell
C Cough HA Headache N Nausea
GW General weakness MJBP Muscle/joint/body pains Vm Vomiting

Symptoms Observed/Reported
NAME 5/23/2022 5/24/2022 Date Date Date
Monday Tuesday Wednesday Thursday Friday
1.AJIBUN, OMAR-SHRIEF A. EN EN
2.BLAGANTIO, JOHN JACOB C. EN A
3.GARCIA, JOHN DAVE T. EN EN
4.PANTON, JOSHRYLL L. EN EN
5.SALDUA, XY YOHAN NATHAN EN EN
6.VILLAROJO, EARL ADRIAN EN EN
7.CABALLERO, JAZMINE ALTHEA P. EN EN
8.FRANCO, SHAKINA GLORY Y. EN EN
9.LIM, VENICE CLAUDETTE R. EN EN
10.CENA, SOPIA KAITH EN EN
11.MANZO, TRIXIE EN EN

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:
FREDILINE B. NACARIO LIEZEL P. CABALLERO
Classroom Adviser Clinic Teacher
Annex C
CLASSROOM DAILY HEALTH MONITORING TOOL FOR COVID-19

Grade Level: Kinder Section: MT. MAYON (A.M.)

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 DB Difficulty of breathing A Absent Others (Please specify)

F/T Fatigue/Tiredness C/RN Colds/runny nose EN Essentially Normal
ST Sore throat R Rashes LoT Loss of taste
LoA Loss of appetite D Diarrhea LoS Loss of smell
C Cough HA Headache N Nausea
GW General weakness MJBP Muscle/joint/body pains Vm Vomiting

Symptoms Observed/Reported
NAME Date Date 2022-08-22 2022-08-25 Date
Monday Tuesday Wednesday Thursday Friday
MALE
1. Amper, Joricho M. EN EN EN EN
2. Bacus, Zed Yhuan H. EN EN EN EN
3. Capunan, Kyle Andrie B. EN EN EN EN
4. Castro, Rj Davnor P. EN EN EN EN
5. Cavan, Kurt R. EN EN EN EN
6. Dy, Christopher Luke M. EN EN EN EN
7. Gabaton, Junlou R. EN EN EN EN
8. Gara, Daryl Than M. EN EN EN EN
9. Guhao, Austin Jay C. EN EN EN EN
10. Lapinosa, Jhunrey D. EN EN EN EN
11. Manguilimotan, Aaron P. EN EN EN EN
12. Pizarra, Vince Zenen B. EN EN EN EN
13. Sanipal, Chrest Lorence S. EN EN EN EN
14. Sarmiento, Angelo- EN EN EN EN
15. Segaril, Marvin Nathan A. EN EN EN EN
FEMALE
1. Amaranto, Rich P. EN EN EN EN
2. Cardo, Angel J. EN EN EN EN
3. Dumacon, Jea EN EN EN EN
4. Fortunado, Krysthel N. EN EN EN EN
5. Jorolan, Ashly Heart A. EN EN EN EN
6. Noynay, Scarlett V. EN EN EN EN
7. Rio, Crisha Pauline G. EN EN EN EN
8. Rodel, Bless Angel Q. EN EN EN EN
9. Sembrano, Carla Luiza A. EN EN EN EN

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:
MONA LIZA S. LUCEÑO LIEZEL P. CABALLERO
Classroom Adviser Clinic Teacher

Grade Level: VI Section: AGILA

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 DB Difficulty of breathing A Absent Others (Please specify)

F/T Fatigue/Tiredness C/RN Colds/runny nose EN Essentially Normal
ST Sore throat R Rashes LoT Loss of taste
LoA Loss of appetite D Diarrhea LoS Loss of smell
C Cough HA Headache N Nausea
GW General weakness MJBP Muscle/joint/body pains Vm Vomiting
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 DB Difficulty of breathing A Absent Others (Please specify)

F/T Fatigue/Tiredness C/RN Colds/runny nose EN Essentially Normal
ST Sore throat R Rashes LoT Loss of taste
LoA Loss of appetite D Diarrhea LoS Loss of smell
C Cough HA Headache N Nausea
GW General weakness MJBP Muscle/joint/body pains Vm Vomiting