Republic of the Philippines

Department of Education
____________________________________________________________________________
SABAS SAGISI MEMORIAL ELEMENTARY SCHOOL
Bacarra I
CLASSROOM DAILY HEALTH MONITORING TOOL FOR COVID-19

Grade Level: 4 Section: NEPTUNE

Instruction: Write under each column date the code(s) observed in the learner during the routine inspection, during the conduct of
t he 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 - Nause
LoA - Loss of Smell EN - Essentially normal GW - General Weakness DB - Difficulty of breathing Vm - Vomiting
Lot - Loss of Taste M/BP-Muscle/joint/body pain A - Absent

Symptoms Observed/Reported
NAME
Monday Tuesday Wednesday Thursday Friday
1. BANDIOLA, LARRY JR
2. BARTOLOME, JOSHGUN
3. BIL, ARMANI EMPORIO
4. CABUGA, RHODMART
5. LOPEZ, RUSTY
6. SABIDO, JHAYNARD
7. SOLIS, MARC LOIUEZ
8. AGULLANA, JAEDI
9. ALBINO, SABRINA
10. CABUGA, RYZZA
11. ELECCION, NAIGHELLE
12. GARO, HAYACINTH
13.GROSPE, NEISHA
14. PARAS, PRINCESS
15. SAGISI, JOSEPHINE
16. SAHAGUN, CHESKA
17. SALVADOR, SIEYAN

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 ClinicTeacher or health
personnel.

Submitted by: Noted by:

ARLENE A. PADILLA PERLITA B. AGNGARAYNGAY

Classroom Adviser Clinic Teacher