Face 2Face Monitoring Tool.docx

RepublicofthePhilippines
DepartmentofEducation
Region II – Cagayan Valley
Schools Division of Nueva Vizcaya
DUPAX DEL SUR NATIONAL HIGH SCHOOL
Dupax del Sur, Nueva Vizcaya
Address: Brgy. Domang, Dupax del Sur, Nueva Vizcaya
Telephone Nos.: (+63)9178925615
Email Address: nv.300628@deped.gov.ph
CLASSROOM DAILY HEALTH MONITORING TOOL FOR COVID-19
Year & 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/RN Colds/runny nose N Nausea LoS Loss of smell Others
NAME of STUDENTS SYMPTOMS OBSERVED/REPORTED
Monday Tuesday Wednesday Thursday Friday

Telephone Nos.: (+63)9178925615
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:
_______________________________ _________________________
T-III/Class Adviser School Nurse

Telephone Nos.: (+63)9178925615
Learners’ Health Checklist
Class A
Learner’s Name Parent/s or
Guardian
Are you suffering from: Body
Temp.
Remark/s
Headache Colds Cough
Body
pain

Telephone Nos.: (+63)9178925615
Prepared by: Noted:
________________________ _____________________________
T-III, Grade III Adviser School Head
DATABASE OF LEARNERS
Class A
Name of Learner Address Contact number of
Parents/Guardian
Days of the Week
Mon. Tue. Wed. Thu. Fri.
Prepared by: Noted:

Telephone Nos.: (+63)9178925615
____________________________ ________________________
Adviser School Head
LEARNERS PROFILE
S.Y. 2022-2023
LRN NAME OF LEARNER AGE BARANGAY PARENTS/
GUARDIAN
MALE
1
104066190002 Ahmed, Raiyaan Tomas
8 Domamg
Father:
Riyas Ahmed
Mother:
Roxanne P. Tomas
Mo
09
2
3

Telephone Nos.: (+63)9178925615
4
5
LEARNER’S PROFILE
S.Y. 2022-2023
LRN NAME OF LEARNER CLASSIFICA-
TION OF
LEARNER
ACCESS OF TRAVEL TO
SCHOOL
VACCINATE
D
WITH
EXISTING
COMORBIDITY
FROM GEOGRA-
PHICALLY
ISOLATED AREA
PARENTAL
CONSENT
Can
walk
going to
school
With
Regul a-
ted
public
transpo
With
Available
private
transpo
YES NO YES NO YES NO YES NO
MALE
1
104066180001
Aguilar,Steven,D. Dependent
√ √ √ √ √ √
2 √ √ √ √ √

Telephone Nos.: (+63)9178925615
3 √ √ √ √ √
4 √ √ √ √ √
5
√ √ √ √ √
6
7
√ √ √ √
REMARKS: 40 34 0 21 7 33 0 40 0 40 40 0
Note: Four (4) Parental Consent are for submission as the parents signified that their children shall join the limited face-to-face classes. The five
(5) without parental consent are those with valid reasons as per evaluation and confirmed that they shall remain with the modular printed
learning due to far distance of their residence to school, residing outside the municipality and earning a living while on modular printed learning.
Total Number of Learners Profiled:
Total Number of Learners to
Join the Limited Face-to-Face-Classes:
Prepared by: Noted by:

Telephone Nos.: (+63)9178925615
____________________________ ________________________________
Class Adviser School Head
ATTENDANCE MONITORING TOOL
Date: ______________________
Grade and Section: ___________________ Group: CLASS A Class Adviser: ______________________
LEARNER’S NAME PARENTS/GUARDIANS
WEEK : _____________________________
MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY

Telephone Nos.: (+63)9178925615
Prepared by: Noted:
______________________ _________________________
Class Adviser Principal I
VACCINATION STATUS OF PARENTS/GUARDIANS
Grade and Section: _______________ Group: CLASS A Class Adviser: _________________
NAME of
PARENTS/GUARDIAN
VACCINE
BRAND
DATE
OF FIRST DOSE
DATE
OF SECOND DOSE
BOOSTER
BRAND
DATE OF BOOSTER
Christopher/Rachel
Asesor
Sinovac September 14,2021 October 8,2021 Pfizer December 15,2021

Telephone Nos.: (+63)9178925615
______________________________ ___________________________________
VACCINATION STATUS OF LEARNERS
Grade and Section: _______________ Group: CLASS A Class Adviser: _________________
NAME OF
LEARNERS
VACCINE
BRAND
DATE
OF FIRST DOSE
DATE
OF SECOND DOSE
BOOSTER
BRAND
DATE OF BOOSTER
Christopher/Rachel
Asesor
Sinovac September 14,2021 October 8,2021 Pfizer December 15,2021

Telephone Nos.: (+63)9178925615
______________________________ ___________________________________

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