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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
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
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
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
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
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
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:
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
____________________________ ________________________
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
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
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 √ √ √ √ √
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
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:
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
____________________________ ________________________________
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
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
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
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
______________________________ ___________________________________
Class Adviser Principal I
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
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
______________________________ ___________________________________
Class Adviser Principal I

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Face 2Face Monitoring Tool.docx

  • 1. 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
  • 2. 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 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
  • 3. 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 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
  • 4. 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 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:
  • 5. 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 ____________________________ ________________________ 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
  • 6. 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 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 √ √ √ √ √
  • 7. 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 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:
  • 8. 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 ____________________________ ________________________________ 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
  • 9. 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 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
  • 10. 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 ______________________________ ___________________________________ Class Adviser Principal I 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
  • 11. 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 ______________________________ ___________________________________ Class Adviser Principal I