Classroom Daily Monitoring Tool

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CLASSROOM DAILY HEALTH MONITORING TOOL FOR COVID-19

Grade Level: Section:

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/RNColds/runny nose N Nausea LoS Loss of smell Others Others

Symptoms Observed or Reported


2021-11-15 2021-11-18 2021-11-23 2021-11-25 2021-11-30
NAME Monday Thursday Tuesday Thursday Tuesday

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:

__________________________ ____________________________
Classroom Adviser Clinic Teacher
Remarks [Indicate how the
Doctor’s Order(s) instructions of the doctor were
[To be initialed by the Medical followed, as well as other actions
Chief Complaint/s taken; e.g., ordered to return to Follow-up Status
(Reason(s) for the Officer upon visit]/ Supported by [As needed;
Time the doctor's Administered By classroom, what time; reported to
Admitted clinic BHERT, specify contact number; Date/Status]
Date Name Age Sex visit/reported Prescription/Instruction Slip Treatment
informed the parent about
symptom(s) instructions, fetched by; etc.]
SUMMARY OF HEALTH STATUS OF PERSONNEL AND LEARNERS
For the Month of: ________________

School: ________________________

Category COVID-19 Status


Name (Personnel/ Grade Date Reported Symptom(s) Action Taken (Referred to) per Follow-Up
Learner) Level/Section Observed/Reported (Positive/Negative)

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