ANNEX E: COVID-19 MONITORING TOOLS
Para sa mga Magulang
Tool
Description
For distribution to parents of learners who will report to school; may be part of the parent's consent that they
will sign in approving learner's physical reporting to school
Notice to Reporting Personnel
For display at the entrance gate and/or for distribution to reporting personnel (may be signed at least once)
Visitor's Declaration Form
For visitors who will enter the school; to be accomplished by the visitor and assessed properly by designated
school staff prior to approval of entry (there must be guidelines as to when visitors may be accommodated and
for what identified purposes)
Teacher's Record
For teachers to keep per class, each day, during health routine inspection (teacher may be provided with step-bystep instruction on how to facilitate the inspection using the tool)
Logsheet
For safekeeping at the Clinic c/o the Clinic Teacher/Nurse to record all cases managed at the Clinic
School Head's Summary
The school head shall keep a summary of the health status of learners and personnel, especially those who will
manifest COVID-19 symptoms for proper monitoring and identification of necessary next steps
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
Symptoms
Fever
Cough
General weakness
Fatigue/Tiredness
Headache
Muscle/joint/body pains
Sore throat
Colds/runny nose
Difficulty of breathing
Loss of appetite
Nausea
Vomiting
Diarrhea
Loss of smell
Loss of taste
Rashes
16
Translation/Description
Lagnat/ang body temperature ay 37.5 C o higit pa
Ubo
Panghihina ng katawan
Pagkapagod
Pananakit ng ulo
Pananakit ng katawan, kalamnan, kasu-kasuan
Pananakit o pamamaga ng lalamunan
Sipon
Pagkahapo o hirap sa paghinga
Kawalan ng ganang kumain
Nasusuka
Pagsusuka
Pagtatae
Pagkawala ng pang-amoy
Pagkawala ng panlasa
Mga butlig sa balat; pamumula ng balat (maaaring makati o hindi)
Others
17
Mga sintomas o obserbasyon sa pangangatawan o pagkilos ng tao/bata na kailangan ng atensyong medikal
Paalala sa mga Magulang/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.
Huwag din po munang papasukin sa eskwelahan ang inyong anak kung siya o ang sinuman sa inyong
sambahayan ay nagpositibo sa COVID-19, naging close contact 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 alternative delivery 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 guarantee the school management that neither you nor
any member of your household experiences any of the following symptoms:
You also confirm that neither you nor any member of your houshold is currently tagged as COVID-19
positive or a close contact of a COVID-19 positive case, or has been diagnosed with pneumonia.
If you experience any of the abovelisted symptoms while you are in school, kindly report immediately
to the School Clinic for appropriate assessment and/or referral as needed.
Health Declaration Form
Source: COMELEC (Note: Ask DOH of standard declaration form, and appropriate action per
reported information [e.g., do not allow entry if they checked "yes" to any statement?], if
available.)
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/RN Colds/runny nose
N Nausea
LoS Loss of smell
Others
NAME
2021-09-13
Monday
2021-09-14
Tuesday
Symptoms Observed/Reported
2021-09-15
2021-09-16
Wednesday
Thursday
2021-09-17
Friday
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
Procedure for Reporting, Management, and Referral
Person
Activities
Means of Verification
Resources Needed
Note: In case of life-threatening emergency, bring the learner to the nearest health facility as soon as possible, while informing the parent of the situation. Necessary first aid
must be provided until the learner is attended by the medical personnel in the facility.
Classroom teacher
Performs initial/basic
Daily Health Monitoring Tool for
Thermometer, printed health
asssessment of the condition of COVID-19
monitoring tool (1 sheet per week per
Step 1
the learner (either through
class)
Classroom teacher
Sends text message to the Clinic
Mobile phone with load
(Option 1)
Teacher informing them about
Step 2a
the symptomatic learner
(Option 1)
Clinic assistant
Clinic assistant
Fetches the symptomatic learner
from the classroom to the clinic
Step 2b
Classroom assistant
Accompanies the symptomatic
Classroom assistant
(Option 2)
learner to the clinic
Step 2
Step 3a
Clinic teacher/nurse
Logs the information of the
Logsheet (Name, reported
Clinic teacher/nurse
Assesses condition of the learner
Step 3b
(Verify the symptoms)
Clinic teacher/nurse
Provides first aid treatment and Referral Slip
Referral Slip
initiates necessary preparations
Emergency Step 4
for sending the learner to the
nearest health facility (e.g.,
Clinic teacher/nurse
Contacts the DepEd Medical
Officer or the MHO/RHU doctor
(in case there is no DepEd
Medical Officer)
DepEd Medical
Officer/MHO/RHU doctor
Provides instruction to the clinic
teacher (which may include
reporting to the BHERT or
sending to the nearest hospital
facility as needed, based on the
Step 4a
Step 4b
Mobile phone with load; contact
information of the Medical Officer
assigned for the school and of the
MHO/RHU doctor; ensure
Logsheet (Doctor's order);
Photo/Soft copy of
Prescription/Instruction Slip (Sent
through Messenger/Viber)
Mobile phone with load (access to
messenger/viber);
Prescription/Instruction Slip
Clinic teacher/nurse
Contacts the parent about the
Logsheet (Remarks; that parent was
condition of the learner if
notified and informed about the
instructed by the Medical Officer, medication to be given)
notifies the parent about the
Medical Officer's instruction,
including prescribed treatment
or medication, and asks the
parent to fetch the child from
school, if needed
Clinic teacher/nurse
Makes necessary preparations
and coordination to send the
learner to the nearest health
facility, if instructed by the
Medical Officer
Clinic teacher/nurse
Contacts the BHERT, if instructed Logsheet (Remarks; Reported case); Mobile phone with load; contact
by the Medical Officer
copy of communications to the
information of the BHERT that has
BHERT (at least text message)
jurisdiction to the residence of the
learner (Clinic needs list of contact
information of all BHERTs of the
learners reporting to the school);
Action Slip (report to BHERT)
Clinic teacher/nurse
Provides first aid treatment as
Logsheet (Doctor's order)
instructed by the Medical Officer
Step 4b.i (As needed)
Step 4b.ii (As needed)
Step 4b.iii (As needed)
Step 5
Path 1
~Mobile phone with load; contact
information of the parent
~Consent to participate in the F2F
classes must cover consent to allow
management of symptoms while in
school (including sending to health
facility in case of emergency, reporting
to BHERT, as needed), as well as crucial
information about the learner's health
(e.g., allergies, medications, etc.) Note:
This particular section will be
Logsheet (Referred to); Referral Slip Mobile phone with load; contact
information of the nearest health
facilities; Referral Slip
Medicines to address symptoms; first
aid kit; other equipment (non-contact
thermometer, pulse oximeter,
nebulizer, forceps, BP apparatus,
oxygen tank, sterilizer); (Refer to list of
equipment that must be present in the
(Option 1)
Clinic assistant
Step 6
Classroom assistant
(Option 2)
Step 6
Path 2a (If parent is asked to fetch the child; from 4bi)
Step 6
Parent
Clinic teacher/nurse
Step 7
Accompanies the learner back to
the classroom once cleared
Fetches the learner from the
clinic to the classroom once
Arrives in the school to fetch the
Provides instruction/important Logbook (Remarks); "May Go
Home"/MGH Slip (with copy signed
information to the parent
by the parent, to be left to the
Guard and then returned to the
Clinic)
MGH Slip, including list of
reminders/instructions for the parent
(including what to monitor; need to
report to BHERT as needed; need to
inform school if the learner tests
Follows-up on the condition of
Logsheet (Follow-up status)
Mobile phone with load; contact
information of the parent
the learner, including results of
The School Head, together with the clinic teacher, is expected to prepare a summary of reported/managed/referred learners, and their condition.
Path 2b (For COVID cases; if learner is referred to BHERT; from 4biii)
Classroom teacher/clinic
Receives information from
Parent's consent form must include a
teacher/nurse
provision that parents are required to
BHERT/parent that the learner(s)
Step 9a
report to the school the COVID-19 test
is/are positive for COVID-19
Classroom teacher/clinic
Informs the school head about
teacher/nurse
the case(s)
Step 9b
Step 8
Clinic teacher/nurse
School head
Step 10a
Step 10b
Step 11a
School head
School head
School head
Step 11b
Step 12
School head
Convenes concerned personnel
to inititate contact tracing
among the classmates and
Prepares the list of all close
contacts of the positive case(s)
Informs the families of the close
contacts about the situation
Informs and submits to their
respective BHERTs incident
reports, providing information
Follows-up on the condition of
the close contacts, including
Incident report
Reminders:
1. Medical certificate/clearance may be required before learners are allowed to return to face-to-face classes, subject to the approval of the DepEd Medical Officer.
2. There must be avaible alternate clinic teachers/nurses to take over the management of the clinic in case the first batch of clinic teachers/nurses become close contacts of a
positive case or test positive for COVID-19.
Date
Time
Admitted
Name
Age
Sex
Grade &
Section
Teacher Adviser
Chief Complaint(s)
[Reason(s) for the clinic
visit/reported symptom(s)]
Doctor's Order
[To be initialed by the Medical Officer
upon visit]/ Supported by the
doctor's Prescription/Instruction
Slip
_ Administer treatment
_ Contact the parents
_ Refer to health facility
_ Report to BHERT
Treatment
Paracetamol 5ml, given at
10:30 am
Administered By
Remarks
[Indicate how the instructions of the doctor were
followed, as well as other actions taken; e.g., ordered to
return to classroom, what time; reported to BHERT,
specify contact number; informed the parent about
instructions, fetched by; etc.]
Follow-up Status
[As needed; Date/Status]
SUMMARY OF HEALTH STATUS OF PERSONNEL AND LEARNERS
For the Month of:
School
Name
Category
Grade Level/Section
(Personnel/Learner)
Date Reported
Symptom(s)
Observed/Reported
Action Taken
(Referred to)
COVID-19 Status per
Follow-Up
MAY GO HOME SLIP
Date:
Name
Age
Sex
Grade/Section
Teacher-Adviser
This certifies that the learner has been provided initial management at the clinic, with instructions from:
Name of Doctor:
The doctor has given instruction that the learner may go home/be fetched by his/her parent/guardian.
Signed:
Clinic Teacher/Nurse
This certifies that I have been provided important information/instructions by the clinic teacher/nurse:
Signed:
Name of fetcher:
Relation to the child:
Time fetched:
Present this May Go Home Slip and cut and leave the upper portion of the slip to the guard before leaving the school.
This lower portion may be brought home by the parent/fetcher.
REMINDERS TO THE PARENT
_ Please monitor the following:
_ Please consult with…
_ Your child has been reported to the BHERT (
); please coordinate with them for the next steps
_ Please inform the school immediately if your child tests positive for COVID-19.
_ Medical certificate/clearance is required before the learner is allowed to return to face-to-face classes, subject to
the approval of the DepEd Medical Officer.
Other instructions:
<Address>
<Name of Doctor>
<Position>
List of symptoms (per DOH DM 2020-0512)
PMA