Republic of the Philippines

Department of Education
Caraga Administrative Region
BISLIG CITY DIVISION
DANIPAS NATIONAL HIGH SCHOOL
P3 Danipas, Labisma, Bislig City

ATTENDANCE & HEALTH CHECKLIST

_______________________ (Activity)
__________________________ (Date/Time/Venue)
Relation Address Contact Past When/ In contact When/ Relation Been in any No. of Atten What/ Experience signs and symptoms like:
with
ship to Number Two Where
someone Where ship location/site Days ded When/Where (Y/N)
the Weeks declared as gath
Temperature

Travelled
Travel Fever Colds Coug Sore Diffic Fatig Diarr
Learner outside potentially ering
Name History Bislig City
(Y/N) infecftive with s: h throat ulty of ue hea
(Abroad COVID 19 (Y/N Breat
/Local/N (Y/N) ) hing
one

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Prepared by Attested: Noted:

_________________ KARMELLE C. ANDOY EVELYN B. LESIGUEZ, PhD
Adviser School Principal PSDS
 CARD DISTRIBUTION & ENROLMENT
July 30, 2021 TLE/Library room (8:30-11:30 Caguyao; 1:30-3:30 Tumanan)
ATTENDANCE & HEALTH CHECKLIST

Relation Address Contact Past Two When/ In contact When/ Relation Been in any No. of Attended What/ Experience signs and symptoms like:
ship to Number Weeks Where with Where ship location/site Days gatherin When/Where (Y/N)
the Travel someone declared as gs:
Learner History Travelled potentially (Y/N) Fever Colds Coug Sore Diffic Fatig Diarr
Name (Abroad/Loc outside infecftive with h throat ulty of ue hea
al/None Bislig City COVID 19 Breat
(Y/N) (Y/N) hing

10

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Prepared by Noted:
MYRANETTE K. CLAR KARMELLE C. ANDOY
Adviser School Principal
 CARD DISTRIBUTION & ENROLMENT
July 30, 2021 TLE/Library room (8:30-11:30 Caguyao; 1:30-3:30 Tumanan)
ATTENDANCE & HEALTH CHECKLIST

Relation Address Contact Past Two When/ In contact When/ Relation Been in any No. of Attended What/ Experience signs and symptoms like:
ship to Number Weeks Where with Where ship location/site Days gatherin When/Where (Y/N)
the Travel someone declared as gs:
Learner History Travelled potentially (Y/N) Fever Colds Coug Sore Diffic Fatig Diarr
Name (Abroad/Loc outside infecftive with h throat ulty of ue hea
al/None Bislig City COVID 19 Breat
(Y/N) (Y/N) hing

21

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Prepared by Noted:
MYRANETTE K. CLAR KARMELLE C. ANDOY
Adviser School Principal
 CARD DISTRIBUTION & ENROLMENT
July 30, 2021 TLE/Library room (8:30-11:30 Caguyao; 1:30-3:30 Tumanan)
ATTENDANCE & HEALTH CHECKLIST

Relation Address Contact Past Two When/ In contact When/ Relation Been in any No. of Attended What/ Experience signs and symptoms like:
ship to Number Weeks Where with Where ship location/site Days gatherin When/Where (Y/N)
the Travel someone declared as gs:
Learner History Travelled potentially (Y/N) Fever Colds Coug Sore Diffic Fatig Diarr
Name (Abroad/Loc outside infecftive with h throat ulty of ue hea
al/None Bislig City COVID 19 Breat
(Y/N) (Y/N) hing

21

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Prepared by Noted:
GLOMERA A. TOYONGAN KARMELLE C. ANDOY
Adviser School Principal
 CARD DISTRIBUTION & ENROLMENT
July 30, 2021 TLE/Library room (8:30-11:30 Caguyao; 1:30-3:30 Tumanan)
ATTENDANCE & HEALTH CHECKLIST

Relation Address Contact Past Two When/ In contact When/ Relation Been in any No. of Attended What/ Experience signs and symptoms like:
ship to Number Weeks Where with Where ship location/site Days gatherin When/Where (Y/N)
the Travel someone declared as gs:
Learner History Travelled potentially (Y/N) Fever Colds Coug Sore Diffic Fatig Diarr
Name (Abroad/Loc outside infecftive with h throat ulty of ue hea
al/None Bislig City COVID 19 Breat
(Y/N) (Y/N) hing

10

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Prepared by Noted:
DELIZA T. OQUIAS-MICU KARMELLE C. ANDOY
Adviser School Principal
 CARD DISTRIBUTION & ENROLMENT
July 30, 2021 Grade 10 classroom (8:30-11:30 Caguyao; 1:30-3:30 Tumanan)
ATTENDANCE & HEALTH CHECKLIST

Relation Address Contact Past Two When/ In contact When/ Relation Been in any No. of Attended What/ Experience signs and symptoms like:
ship to Number Weeks Where with Where ship location/site Days gatherin When/Where (Y/N)
the Travel someone declared as gs:
Learner History Travelled potentially (Y/N) Fever Colds Coug Sore Diffic Fatig Diarr
Name (Abroad/Loc outside infecftive with h throat ulty of ue hea
al/None Bislig City COVID 19 Breat
(Y/N) (Y/N) hing

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Prepared by Noted:
JAME-SON G. JUBANE KARMELLE C. ANDOY
Adviser School Principal