CHSE DAILY HEALTH

CHECKLIST FOR 1ST

SEMESTER AY 2022-23
ainaangelly.santos@olivarezcollege.edu.ph
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* Required

HEALTH CHECKLIST

State whether you've experienced/are experiencing

the following:
:
 *

YES NO

FEVER (For the

past few days)

COUGH

COLDS

SHORTNESS OF
BREATH

PERSISTENT
PAIN IN THE
CHEST

BODY PAINS

HEADACHE

DIARRHEA

SORE THROAT

LOSS OF SMELL

LOSS OF TASTE
:
  HAVE YOU WORKED TOGETHER OR STAYED *
IN THE SAME CLOSED ENVIRONMENT OF A
CONFIRMED CoVID-19 CASE?

YES

NO

HAVE YOU HAD ANY CONTACT WITH *

ANYONE WITH FEVER, COUGH, COLDS, AND
SORE THROAT IN THE PAST TWO (2)
WEEKS?

YES

NO

HAVE YOU TRAVELLED TO ANY AREA IN NCR *

ASIDE FROM YOUR HOME?

YES

NO

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