CLASSROOM DAILY HEALTH MONITORING TOOL FOR COVID-19

Teachers Record
Grade Level: GRADE 6 Section: VENUS

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 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 Nausea LoS Loss of smell EN Essentially Normal
GW General weakness MJBP Muscle/joint/body pains DB Difficulty of breathing Vm Vomiting LoT Loss of taste A Absent
Others (Please specify)
Symptoms Observed/Reported
NAME 2022-03-14 2022-03-15 2022-03-16 2022-03-17 2022-03-18
Monday Tuesday Wednesday Thursday Friday

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:

ISRAEL E. VENIEGAS MARIA HOMITA F. ELAN

Classroom Adviser Clinic Teacher
 Republic of the Philippines
Department of Education
REGION III-CENTRAL LUZON
SCHOOLS DIVISION OF ZAMBALES
IBA DISTRICT
LITTLE BAGUIO ELEMENTARY SCHOOL

CLASSROOM DAILY HEALTH MONITORING TOOL FOR COVID-19

GRADE 6 - VENUS

Prepared:
ISRAEL E. VENIEGAS

Noted:
MELANIE S. CAPILI

Little Baguio Elementary School

Purok 2, Bangantalinga, Iba, Zambales
106877@deped.gov.ph