Republic of the Philippines

Department of Education
REGION VIII-EASTERN VISAYAS
SCHOOLS DIVISION OF EASTERN SAMAR
GUIUAN NATIONAL HIGH SCHOOL
Guiuan, Eastern Samar

SENIOR HIGH SCHOOL DEPARTMENT

CLASSROOM DAILY HEALTH MONITORING TOOL FOR COVID-19

Grade Level: 12-HUMSS Section: 3
Week No: ________________ Time: ________
Name of Teacher: __________________ Subject: _____________________
Instruction: Write under each column date the time in, time out, body temperature and the code 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:

Fe 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 Others

Symptoms Observed/Reported

 03/07/22 03/08/22  03/09/22  03/10/22  03/11/22 

SET A Learners
Monday Tuesday Wednesday Thursday Friday
TIME TIME BODY SYMPT. TIME TIME BODY SYMPT. TIME TIME BODY SYMPT. TIME TIME BODY SYMPT. TIME TIME BODY SYMPT.
IN OUT TEMP. CODE IN OUT TEMP CODE IN OUT TEMP. CODE IN OUT TEMP. CODE IN OUT TEMP. CODE

1. ALDAYA,JONARD -
         
2. BADE,CALBERT NIÑO ABULENCIA
         
3. BASARIO,JAYPEE MACABOCSIT
         
4. CABUGAWAN,ANTONIO PADRO
         
5. DE GUIA,JAN CARLO ECLEO
         
6. DURAN,RAMON JR MORANTE
         
Symptoms Observed/Reported

03/07/22 03/08/22 03/09/22 03/10/22 03/11/22

SET A Learners
Monday Tuesday Wednesday Thursday Friday
TIME TIME BODY SYMPT. TIME TIME BODY SYMPT. TIME TIME BODY SYMPT. TIME TIME BODY SYMPT. TIME TIME BODY SYMPT.
IN OUT TEMP. CODE IN OUT TEMP CODE IN OUT TEMP CODE IN OUT TEMP CODE IN OUT TEMP CODE

7. ECLEO,JORICO SALONGCONG
       
8. GAGATIGA,KIM JOHN AHIL
         
9. MACHICA,JOHN SHERWIN ECO

10. ROMANCA,JESON TOMALE

11. SALAZAR,JAYDEN LUKE FAUSTINE

DURAN
12. CABAGUING,NIMFA PAGAYANAN

13. CARAÑAGAN,MIKKA JANE

SEPUESCA
14. GUASIS,CHRISTINE JUNE BAGRO

15. HINGPIS,HIDDY VASQUEZ

16. IDA,NIÑA MAE RANIDO

 
17. LUMAGBAS,HANNAH GRACE
BIONG
 18. MACAWILE,ANGEL MARIE
CAPAGALAN
19. PADUL,ANGEL LYKA SABARILLO

20. SERVANO,DANNICA TRIXIE

SALAZAR
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:

IVES D. SALAZAR EMILY A. SABULAO

Adviser/Subject Teacher School Nurse

Republic of the Philippines

Address: Cogon, Guiuan, E. Samar 6809, Philippines
Department of Education
Guiuan National High School
E-mail Address: [email protected]
REGION VIII-EASTERN VISAYAS
SCHOOLS DIVISION OF EASTERN SAMAR
GUIUAN NATIONAL HIGH SCHOOL
Guiuan, Eastern Samar

SENIOR HIGH SCHOOL DEPARTMENT

CLASSROOM DAILY HEALTH MONITORING TOOL FOR COVID-19

Grade Level: _____________ Section: __________________
Week No: ________________ Time: ________
Name of Teacher: __________________ Subject: _____________________
Instruction: Write under each column date the code ( ) of the symptom( ) 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:
 Fe 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 Others

Symptoms Observed/Reported

 03/14/22 03/15/22  03/16/22  03/17/22  03/18/22 

SET B Learners
Monday Tuesday Wednesday Thursday Friday
TIME TIME BODY SYMPT. TIME TIME BODY SYMPT. TIME TIME BODY SYMPT. TIME TIME BODY SYMPT. TIME TIME BODY SYMPT.
IN OUT TEMP. CODE IN OUT TEMP CODE IN OUT TEMP. CODE IN OUT TEMP. CODE IN OUT TEMP. CODE

1. PAGAYANAN,MARCO ARTASTE
         
2. YODICO,MICKO POLANCO
         
3. BAGASON,JOVELYN ABUYEN
         
4. BAGUAL,ROSELYN ESCALANTE
         
5. CABANATAN,ERIANN ABUD
         
6. CABUS,MARIA STEPHANIE GACITA
         
Symptoms Observed/Reported

 03/14/22 03/15/22  03/16/22  03/17/22  03/18/22 

SET B Learners
Monday Tuesday Wednesday Thursday Friday
TIME TIME BODY SYMPT. TIME TIME BODY SYMPT. TIME TIME BODY SYMPT. TIME TIME BODY SYMPT. TIME TIME BODY SYMPT.
IN OUT TEMP. CODE IN OUT TEMP CODE IN OUT TEMP CODE IN OUT TEMP CODE IN OUT TEMP CODE

7. DADO,SHENNA ROSE
PAGATPATAN        
8. DAGSA,EMMA ROSE ABANTAW
         
 9. GAYOSO,MECHAELA ABOGADIE

10. LACASA,LUCILA PAGAD

11. LUCERO,HAZEL MAE ROMANCA

12. MACASA,SAIRA MARTILLANO

13. MACHICA,ROSELYN DAGANIO

14. MALIBAGO,AHLYNNER MEJECA

15. NACIONGAYO,JESSELYN -

16. NAING,PRINCESS JULIE MACASUSI

 
17. OPRIASA,MARVIC SEVILLA

18. OPRIN,NICKA BITOY

19. PADERAN,LOVELY OGARDO

20. PADING,ROWENA SALCEDA

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:

IVES D. SALAZAR EMILY A. SABULAO

Adviser/Subject Teacher School Nurse

Address: Cogon, Guiuan, E. Samar 6809, Philippines

Guiuan National High School
E-mail Address: [email protected]