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    Cecilio Apostol Elementary School Attendees' Health Checklist

    Uploaded by

    Mikoy Fordan Antolino
    This document is a health checklist for attendees of Cecilio Apostol Elementary School. It asks for the attendee's name, address, contact number, and temperature. It then asks a series of yes or no questions regarding COVID-19 symptoms the attendee may be experiencing like sore throat, body pains, or fever. It also asks if the attendee has been in contact with a confirmed COVID-19 case, traveled outside the Philippines in the last 14 days, or traveled within Metro Manila aside from their home. By signing, the attendee authorizes the school to collect and process this health data to help control the spread of COVID-19 infection.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd

    Cecilio Apostol Elementary School Attendees' Health Checklist

    Uploaded by

    Mikoy Fordan Antolino
    129 views1 page
    This document is a health checklist for attendees of Cecilio Apostol Elementary School. It asks for the attendee's name, address, contact number, and temperature. It then asks a series of yes or no questions regarding COVID-19 symptoms the attendee may be experiencing like sore throat, body pains, or fever. It also asks if the attendee has been in contact with a confirmed COVID-19 case, traveled outside the Philippines in the last 14 days, or traveled within Metro Manila aside from their home. By signing, the attendee authorizes the school to collect and process this health data to help control the spread of COVID-19 infection.

    Original Title

    COVID-CHECKLIST-letter-size (1).docx

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    This document is a health checklist for attendees of Cecilio Apostol Elementary School. It asks for the attendee's name, address, contact number, and temperature. It then asks a series of yes or no questions regarding COVID-19 symptoms the attendee may be experiencing like sore throat, body pains, or fever. It also asks if the attendee has been in contact with a confirmed COVID-19 case, traveled outside the Philippines in the last 14 days, or traveled within Metro Manila aside from their home. By signing, the attendee authorizes the school to collect and process this health data to help control the spread of COVID-19 infection.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    129 views1 page

    Cecilio Apostol Elementary School Attendees' Health Checklist

    Uploaded by

    Mikoy Fordan Antolino
    This document is a health checklist for attendees of Cecilio Apostol Elementary School. It asks for the attendee's name, address, contact number, and temperature. It then asks a series of yes or no questions regarding COVID-19 symptoms the attendee may be experiencing like sore throat, body pains, or fever. It also asks if the attendee has been in contact with a confirmed COVID-19 case, traveled outside the Philippines in the last 14 days, or traveled within Metro Manila aside from their home. By signing, the attendee authorizes the school to collect and process this health data to help control the spread of COVID-19 infection.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 1

    CECILIO APOSTOL ELEMENTARY SCHOOL

    ATTENDEES’ HEALTH CHECKLIST

    NAME: TEMPERATURE:
    ADDRESS: _________________________________________ CONTACT NO. _________________

    YES NO
    1. Are you experiencing (nakakaranas ka ba ng mga sumusunod:
    a. Sore throat
    (pananakit ng lalamunan/masakit lumonok)
    b. Body Pains
    (Pananakit ng katawan)
    c. Headache
    (Pananakit ng ulo)
    d. Fever for the past few days
    ( lagnat sa nakalipas na araw)
    e. Shortness of breath
    (hirap sa paghinga)
    2. Have you worked together or stayed in the same closed
    environment of a confirmed COVID-19 case?
    (May nakasama ka ba o nakatrabahong tao na kumpirmadong may
    COVID-19/may impeksyon ng corona virus?
    3. Have you had any contact with anyone with fever, cough, colds,
    sore throats in the past 2 weeks?
    (Mayroon ka bang nakasama na may lagnat, ubo, o sipon o sakit ng
    lalamunan sa nakalipas na dalawang (2) linggo?
    4. Have you travelled outside the Philippines in the Last 14 days?
    (Ikaw ba ay nagbiyahe sa labas ng Pilipinas sa nakalipas na 14 na
    araw?
    5. Have you travelled to any area in NCR aside from your home?
    (Ikaw ba ay nagpunta sa ibang parte ng NCR o Metro Manila
    bukod sa iyong bahay?)
    Kung Oo, saan ? (Pls. Specify)

    I hereby authorize CECILIO APOSTOL ELEMENTARY SCHOOL to collect and process the
    data included herein for the purpose of effecting control of COVID-19 infection. I understand that my
    personal information is protected by RA 10173, Data Privacy Act of 2012, and that I am required by
    RA 11469, Bayanihan to Heal as One Act, to provide truthful information.

    SIGNATURE: _________________________________

    DATE: _______________________________________

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