ANNEX E: COVID-19 MONITORING TOOLS
Tool Description
Para sa mga Magulang For distribution to parents oflearners who will report to school; may bepart oftheparent's consent that they
will sign in approving learner's physical reporting to school
Noticeto Reporting Personnel For display at theentrancegateand/or for distribution to reporting personnel (may besigned at least once)
Visitor's Declaration Form For visitors who will enter theschool; to beaccomplished by thevisitor and assessed properly by designated
school staffprior to approval ofentry (theremust beguidelines as to when visitors may beaccommodated and
for what identified purposes)
Teacher's Record For teachers to keep per class, each day, during health routineinspection (teacher may beprovided with step-by-
step instruction on how to facilitatetheinspection using thetool)
Logsheet For safekeeping at theClinic c/o theClinic Teacher/Nurseto record all cases managed at theClinic
School Head's Summary Theschool head shall keep a summary ofthehealth status oflearners and personnel, especially thosewho will
manifest COVID-19 symptoms for proper monitoring and identification ofnecessary next steps

Symptoms Translation/Description
01 Fever Lagnat/ang body temperatureay 37.5 C o higit pa
02 Cough Ubo
03 General weakness Panghihina ng katawan
04 Fatigue/Tiredness Pagkapagod
05 Headache Pananakit ng ulo
06 Muscle/joint/body pains Pananakit ng katawan, kalamnan, kasu-kasuan
07 Sorethroat Pananakit o pamamaga ng lalamunan
08 Colds/runny nose Sipon
09 Difficulty ofbreathing Pagkahapo o hirap sa paghinga
10 Loss ofappetite Kawalan ng ganang kumain
11 Nausea Nasusuka
12 Vomiting Pagsusuka
13 Diarrhea Pagtatae
14 Loss ofsmell Pagkawala ng pang-amoy
15 Loss oftaste Pagkawala ng panlasa
16
Rashes
Mga butlig sa balat; pamumula ng balat (maaaring makati o hindi)
17
Others
Mga sintomas o obserbasyon sa pangangatawan o pagkilos ng tao/bata na kailangan ng atensyong medikal

PaalalasamgaMagulang/Guardian
Kung ang inyong anak po o ang sinuman sa inyong sambahayan ay kasalukuyang nakararanas o
nakaranas sa nakalipas na 14 na araw ng alinman sa mga sumusunod na sintomas, mangyari pong
huwag na munang papasukin ang bata sa eskwela.
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Huwag din po munang papasukin sa eskwelahan ang inyong anak kung siya o ang sinuman sa inyong
sambahayan ay nagpositibo sa COVID-19, naging closecontact ng COVID-19 case, o nadiagnose sa
pneumonia.
Ipagbigay alam po agad ang sitwasyon sa kanilang guro na si G/Gng/Bb. _______________, sa
numero bilang ___________________, upang maisaayos ang alternativedelivery mode para sa
kanilang pag-aaral habang sila ay nasa bahay.
Mangyari pong imonitor ang kondisyon ng inyong anak o kasama sa bahay, at iulat sa inyong
Barangay Health Emergency Response Team (BHERT), Barangay Health Station, o Rural Health Unit,
kung kinakailangan, upang sila ay mabigyan ng kaukulang lunas.
Ipinapabatid din po ng pamunuan ng ___________________________________ na imomonitor po
ng kanilang mga guro ang mga mag-aaral na pumapasok sa paaralan at ipagbibigay-alam agad sa
inyo at sa mga kinauukulan kung sila ay ma-obserbahan o maiulat na nakakaranas ng alinman sa
mga sintomas na nabanggit sa itaas.
Mangyari pong itago o idisplay sa inyong bahay ang paalalang ito upang magsilbing gabay para sa

Notice to Reporting Personnel
By proceeding to report to school today, you guaranteethe school management that neither you nor
any member of your household experiences any ofthe following symptoms:
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You also confirm that neither you nor any member of your houshold is currently tagged as COVID-19
positiveor a close contact ofa COVID-19 positivecase, or has been diagnosed with pneumonia.
If you experienceany of theabovelisted symptoms whileyou are in school, kindly report immediately
to theSchool Clinic for appropriateassessment and/or referral as needed.

Health Declaration Form
Source: COMELEC (Note: Ask DOH ofstandard declaration form, and appropriateaction per
reported information [e.g., do not allow entry ifthey checked "yes"to any statement?], if
available.)

Grade Level: Section:
2021-09-13 2021-09-14 2021-09-15 2021-09-16 2021-09-17
Monday Tuesday Wednesday Thursday Friday
Submitted by: Noted by:
Classroom Adviser Clinic Teacher
CLASSROOM DAILY HEALTH MONITORING TOOL FOR COVID-19
NAME
Note: As soon as any ofthelisted symptoms is observed among any ofthelearners, theteacher is expected to send thelearner to theSchool Clinic immediately for theproper
management by theSchool Clinic Teacher or health personnel.
SymptomsObserved/Reported
Instruction: Writeunder each column datethecode(s) of thesymptom(s) observed in thelearner during theroutineinspection, during theconduct oftheclass, or as
reported by the learner or their classmates. Refer to thelist ofsymptoms below and their respectivecodes:
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 ofsmell Others

Person Activities MeansofVerification ResourcesNeeded
Step 1
Classroom teacher Performs initial/basic
asssessment ofthecondition of
thelearner (either through
routineinspection or as observed
Daily Health Monitoring Tool for
COVID-19
Thermometer, printed health
monitoring tool (1 sheet per week per
class)
(Option 1)
Step 2a
Classroom teacher Sends text messageto theClinic
Teacher informing them about
thesymptomatic learner
Mobilephonewith load
(Option 1)
Step 2b
Clinic assistant Fetches thesymptomatic learner
from theclassroom to theclinic
Clinic assistant
(Option 2)
Step 2
Classroom assistant Accompanies thesymptomatic
learner to theclinic
Classroom assistant
Step 3a Clinic teacher/nurse Logs theinformation ofthe
learner
Logsheet (Name, reported
symptoms)
Step 3b
Clinic teacher/nurse Assesses condition ofthelearner
(Verify thesymptoms)
Emergency Step 4
Clinic teacher/nurse Provides first aid treatment and
initiates necessary preparations
for sending thelearner to the
nearest health facility (e.g.,
preparereferral slip, facilitate
Referral Slip Referral Slip
Step 4a
Clinic teacher/nurse Contacts theDepEd Medical
Officer or theMHO/RHU doctor
(in casethereis no DepEd
Medical Officer)
Mobilephonewith load; contact
information oftheMedical Officer
assigned for theschool and ofthe
MHO/RHU doctor; ensure
arrangement with theMHO/RHU
Step 4b
DepEd Medical
Officer/MHO/RHU doctor
Provides instruction to theclinic
teacher (which may include
reporting to theBHERTor
sending to thenearest hospital
facility as needed, based on the
assessment oftheMedical
Logsheet (Doctor's order);
Photo/Soft copy of
Prescription/Instruction Slip (Sent
through Messenger/Viber)
Mobilephonewith load (access to
messenger/viber);
Prescription/Instruction Slip
Procedure for Reporting, Management, and Referral
Note: In caseoflife-threatening emergency, bring thelearner to thenearest health facility as soon as possible, whileinforming theparent ofthesituation. Necessary first aid
must beprovided until thelearner is attended by themedical personnel in thefacility.

Step 4b.i (As needed)
Clinic teacher/nurse Contacts theparent about the
condition ofthelearner if
instructed by theMedical Officer,
notifies theparent about the
Medical Officer's instruction,
including prescribed treatment
or medication, and asks the
parent to fetch thechild from
school, ifneeded
Logsheet (Remarks; that parent was
notified and informed about the
medication to begiven)
~Mobilephonewith load; contact
information oftheparent
~Consent to participatein theF2F
classes must cover consent to allow
management ofsymptoms whilein
school (including sending to health
facility in caseofemergency, reporting
to BHERT, as needed), as well as crucial
information about thelearner's health
(e.g., allergies, medications, etc.) Note:
This particular section will be
Step 4b.ii (As needed)
Clinic teacher/nurse Makes necessary preparations
and coordination to send the
learner to thenearest health
facility, ifinstructed by the
Medical Officer
Logsheet (Referred to); Referral Slip Mobilephonewith load; contact
information ofthenearest health
facilities; Referral Slip
Step 4b.iii (As needed)
Clinic teacher/nurse Contacts theBHERT, ifinstructed
by theMedical Officer
Logsheet (Remarks; Reported case);
copy ofcommunications to the
BHERT(at least text message)
Mobilephonewith load; contact
information oftheBHERTthat has
jurisdiction to theresidenceofthe
learner (Clinic needs list ofcontact
information ofall BHERTs ofthe
learners reporting to theschool);
Action Slip (report to BHERT)
Step 5
Clinic teacher/nurse Provides first aid treatment as
instructed by theMedical Officer
Logsheet (Doctor's order) Medicines to address symptoms; first
aid kit; other equipment (non-contact
thermometer, pulseoximeter,
nebulizer, forceps, BP apparatus,
oxygen tank, sterilizer); (Refer to list of
equipment that must bepresent in the
clinic beforetheschool is allowed to
Path 1

(Option 1)
Step 6
Clinic assistant Accompanies thelearner back to
theclassroom oncecleared
(Option 2)
Step 6
Classroom assistant Fetches thelearner from the
clinic to theclassroom once
cleared
Step 6 Parent Arrives in theschool to fetch the
learner
Step 7
Clinic teacher/nurse Provides instruction/important
information to theparent
Logbook (Remarks); "May Go
Home"/MGH Slip (with copy signed
by theparent, to beleft to the
Guard and then returned to the
Clinic)
MGH Slip, including list of
reminders/instructions for theparent
(including what to monitor; need to
report to BHERTas needed; need to
inform school ifthelearner tests
positive; when to seek clearanceprior
Step 8
Clinic teacher/nurse Follows-up on thecondition of
thelearner, including results of
COVID-19 test (ifapplicable)
Logsheet (Follow-up status) Mobilephonewith load; contact
information oftheparent
Step 9a
Classroom teacher/clinic
teacher/nurse
Receives information from
BHERT/parent that thelearner(s)
is/arepositivefor COVID-19
Parent's consent form must includea
provision that parents arerequired to
report to theschool theCOVID-19 test
results oftheir children
Step 9b
Classroom teacher/clinic
teacher/nurse
Informs theschool head about
thecase(s)
Step 10a
School head Convenes concerned personnel
to inititatecontact tracing
among theclassmates and
teacher(s) ofthepositivecase(s)
Step 10b
School head Prepares thelist ofall close
contacts ofthepositivecase(s)
Step 11a
School head Informs thefamilies oftheclose
contacts about thesituation
Step 11b
School head Informs and submits to their
respectiveBHERTs incident
reports, providing information
about thesituation, and thelist
Incident report
Step 12
School head Follows-up on thecondition of
theclosecontacts, including
results ofCOVID-19 tests (if
Path 2b (For COVID cases; iflearner isreferred to BHERT; from 4biii)
TheSchool Head, together with theclinic teacher, is expected to preparea summary ofreported/managed/referred learners, and their condition.
Reminders:
1. Medical certificate/clearancemay berequired beforelearners areallowed to return to face-to-faceclasses, subject to theapproval oftheDepEd Medical Officer.
2. Theremust beavaiblealternateclinic teachers/nurses to takeover themanagement oftheclinic in casethefirst batch ofclinic teachers/nurses becomeclosecontacts ofa
positivecaseor test positivefor COVID-19.
Path 2a(Ifparent isasked to fetch the child; from 4bi)

Date Time
Admitted
Name Age Sex Grade&
Section
Teacher Adviser ChiefComplaint(s)
[Reason(s) for theclinic
visit/reported symptom(s)]
Doctor'sOrder
[To beinitialed by theMedical Officer
upon visit]/ Supported by the
doctor's Prescription/Instruction
Slip
Treatment Administered By Remarks
[Indicatehow theinstructions ofthedoctor were
followed, as well as other actions taken; e.g., ordered to
return to classroom, what time; reported to BHERT,
specify contact number; informed theparent about
instructions, fetched by; etc.]
Follow-up Status
[As needed; Date/Status]
_Administer treatment
_Contact the parents
_Refer to health facility
_Report to BHERT
Paracetamol 5ml, given at
10:30 am

School
Name Category
(Personnel/Learner)
Grade Level/Section Date Reported Symptom(s)
Observed/Reported
Action Taken
(Referred to)
COVID-19 Statusper
Follow-Up
(Positive/Negative)
SUMMARY OF HEALTH STATUS OF PERSONNEL AND LEARNERS
For the Month of: ________________

MAY GOHOMESLIP
Date:
Name
Age
Sex
Grade/Section
Teacher-Adviser
This certifies that thelearner has been provided initial management at theclinic, with instructions from:
Name ofDoctor:
Thedoctor has given instruction that thelearner may go home/befetched by his/her parent/guardian.
Signed:
Clinic Teacher/Nurse
This certifies that I havebeen provided important information/instructions by theclinic teacher/nurse:
Signed:
Nameoffetcher:
Relation to thechild:
Timefetched:
Present this May Go Home Slip and cut and leave the upper portion ofthe slip to the guard before leaving the school.
This lower portion may be brought home by the parent/fetcher.
REMINDERS TOTHEPARENT
_Pleasemonitor thefollowing:
_Pleaseconsult with…
_Your child has been reported to theBHERT( __________________); pleasecoordinatewith them for thenext steps
_Pleaseinform theschool immediately ifyour child tests positivefor COVID-19.
Other instructions:
_Medical certificate/clearanceis required beforethelearner is allowed to return to face-to-faceclasses, subject to
theapproval oftheDepEd Medical Officer.

<Address>
<Name ofDoctor>
<Position>

List ofsymptoms (per DOH DM2020-0512)
PMA