Republic of the Philippines

Department of Education
Region IV-A CALABARZON
SCHOOLS DIVISION OF RIZAL
JALAJALA SUB-OFFICE
SIPSIPIN ELEMENTARY SCHOOL
__________________________________________________________________________

1
 Republic of the Philippines
Department of Education
Region IV-A CALABARZON
SCHOOLS DIVISION OF RIZAL
JALAJALA SUB-OFFICE
SIPSIPIN ELEMENTARY SCHOOL
__________________________________________________________________________

SCHOOL SAFETY ASSESSMENT TOOL FOR FACE-FACE-LEARNING MODALITY

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1. The school has secured support of LGUs(Barangay,
Municipality, City, Province) through a resolution or a
letter of support.

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2. The school has secured written consent from
parents/guardians who will participate in the limited face-
to-face classes.

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3. The school has mobilized resources and support from
community stakeholders to meet the standards of the
health and safety protocols.

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4. The school has conducted simulation activities among
school personnel regarding protocols and routines to
replicate and discuss possible scenarios during the actual
conduct of face-to-face classes.
II. ALTERNATIVE WORK ARRANGEMENT

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1. The school has implemented an Alternative Work
Arrangement necessary to deliver quality basic education
in a safe learning environment to learners. a. Number of
teachers who physically report meets the required teacher:
learner ratio
b. Teachers who physically report are 65 years old and below
c. Teachers who physically report to not have comorbidities,
immune deficiency, or any health risk/conditions
d. Teachers who have service vehicles from and to area of
residence and school e. Teachers who physically report are
from within the city/municipality where school/learning center is
located

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2. The school has oriented teaching personnel and non-
teaching personnel on the Alternative Work Arrangement
that will be implemented during the limited face-to-face
classes.
III. CLASSROOM LAYOUT AND STRUCTURE

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1. The school has established mechanisms inside the
classroom to ensure zero to minimal risk of COVID-l9
transmission of the learners.
a. Number of seats to be occupied must not exceed from the
required number of maximum learners in the classroom
b. Seats to be occupied must be at least 1-2 meter apart
c. Numbers of seats shall be equivalent to the number of
learners present
d. Presence of markers and stickers on the floor to manage
traffic system and physical distancing inside the classroom
e. Availability of working electric fans
f. Open windows and doors at all times
g. Installation of appropriate ventilation equipment such as
general and exhaust ventilation and CO2 monitoring devices
h. Availability of a sterilization box where outputs (e.g., quiz
papers) submitted by the learners will be placed for
disinfection.
i. Usage of high-efficiency particulate air (IIEPA) filtration air
purifiers to clean recirculated air for air-conditioned spaces,

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 Republic of the Philippines
Department of Education
Region IV-A CALABARZON
SCHOOLS DIVISION OF RIZAL
JALAJALA SUB-OFFICE
SIPSIPIN ELEMENTARY SCHOOL
__________________________________________________________________________
provided that the unit is adequate for the size of the room in
which it is installed
IV. SCHOOL TRAFFIC MANAGEMENT

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1. The school has set-up clear and easy-to-understand
signages, preferably in local languages and Braille, and
mechanisms to strengthen observance of health protocols
and protective measures.
a. Display of school map at the entrance point indicating the
location of the classrooms
b. Designation of separate entrance and exit points in the
school
c. Designation of separate entrance and exit points in high
traffic areas (unidirectional markers, installation of signages for
cueing and unidirectional movement, sectioning& and queuing)
d. Designated entrance and exit points in the classrooms
e. Hallway ground markings for walking direction guide
f. Designation of areas for queue (e.g., restroom, library,
principal's office, etc.)
V. PROTECTIVE MEASURES, HYGIENE PRACTICES, AND
SAFETY PROCEDURES

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1. The school has established safe entrance and exit
procedures for teachers, students, non-teaching
personnel, and school visitors.
a. Availability of temperature thermal scanner or thermal gun
in entrance and/or exit gates
b. Availability of hand sanitizer or alcohol dispenser in school
gates
c. Availability of surgical masks at school entrance reserved for
symptomatic individuals

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2. The school has established a contact tracing procedure
tools for school goers.
a. Health declaration sheet for school personnel
b. Health declaration sheet for students
c. Contact tracing tool for school-goers

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3. The school has mobilized the School COVID-19 DRRM
team that will take charge in ensuring effective
implementation of the school's health and safety protocols
that are in place and are observed during the preparation
and implementation of limited face-to-face classes.
a. Designation of a Safety Officer who shall serve as the focal
person for the health and safety protocols of the school

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4. The school has set up a proper sanitation and hygiene
facility for school goers.
a. Availability of hand washing station with clean and safe
water supply b. Availability of clean and safe toilet facilities
c. Schedule of supervised hand washing and tooth brushing
activities
d. Placement of hand washing facilities in a strategic location
(e.g., school entrance)
e. Placement of trash bins in strategic locations
f. Visuals signages on proper waste management practices
near trash bins

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5. The school has ensured regular sanitation and
disinfection of school facilities, furniture, and equipment.
a. Schedule of sanitation of frequently touched surfaces (e.g.,
table, doorknobs, light switches, etc.) every after end of a
school shift
b. Schedule of disinfection of school facilities (e.g., chairs,

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 Republic of the Philippines
Department of Education
Region IV-A CALABARZON
SCHOOLS DIVISION OF RIZAL
JALAJALA SUB-OFFICE
SIPSIPIN ELEMENTARY SCHOOL
__________________________________________________________________________
desk, blackboard, toilet facilities)
c. Availability of sanitation and disinfecting materials

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6. The school has ensured a proper disposal system of
infectious wastes, such as used tissues and masks, in
non-contact receptacles.
a. Disposal of all used PPEs in a separate leak-proof yellow
trash bag/container with a cover properly labeled as "USED
PPE"
b. Collection of the leak-proof yellow hash bag/container
regularly or twice a day (after end of class and after working
day) from designated/specific area to the general collection
area for treatment and disposal
c. Availability of medical-grade face mask required for school
personnel when collecting/handling the leak-proof yellow trash
bag/container
d. Treatment through disinfection or spraying of the collected
wastes with a chlorine solution (1:10) in accordance with DOH
Department Memorandum No.2O20-0'1,57 " Guidelines on
Cleaning and Disinfection in Various Settings as an Infection
Pretention and Control Measure Against covlD-19"
e. Disposal of the disinfected PPE with general waste to the
final disposal facility
VI. COMMUNICATION STRATEGY

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1. The school has developed a communication plan.
a. Identification of plat form of communication for
coordination purposes among the learners,
parents/guardians, and teachers
b. Database of contact details including contact number and
address of parents/guardians of the learners are kept to inform
them in case their child shows flu-like symptoms while in
school premises
c. Development of child-friendly information, Education and
Communication (IEC) materials on hygiene practices and
respiratory etiquette including hand hygiene (hand disinfection
thru hand washing and/or use of 70% isopropyl alcohol),
respiratory hygiene and cough etiquette (coughing or sneezing
into tissues or one's elbow), protective measures (proper use
of face shield and face mask, physical distancing), among
others, that are posted in common areas and are available in
local languages and braille.

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2. The school has prepared an orientation session for
learners, parent6, guardians, teaching and non-teaching
personnel, external stakeholders, and LGU of the eligibility
criteria for participation existing protocols, mechanisms,
and procedures needed in the conduct of the limited face-
to-face classes.
a. Schedule of the orientation (at least one week prior to the
conduct of the face-to-face classes)
b. Orientation materials are made available for distribution to
teachers, learners, parents, BLGU, DRRM team members, and
persons-in-charge in ensuring observance of protocols,
mechanisms, and procedures For schools that did not meet all
indicators, the SDOs shall inform them of their unmet indicators
and shall provide technical assistance to help them prepare for
the limited face-to-face learning modality.

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3. The school has a proactive COVID-19 local hotline/help
desk or any similar local mechanism that connects and
coordinates to the hospitals, testing facilities, and LGUs.

4
 Republic of the Philippines
Department of Education
Region IV-A CALABARZON
SCHOOLS DIVISION OF RIZAL
JALAJALA SUB-OFFICE
SIPSIPIN ELEMENTARY SCHOOL
__________________________________________________________________________

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4. The school has prepared a re-orientation session for school
stakeholders on measures needed for the reopening of the
school in the event of resurgences and school lockdown.
VII. CONTIGENCY PLAN

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1. The school has followed a decision model and contingency
plan for reclosing and reopening the school in case of COVID-
19 resurgence in the community.

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2. The school has developed strategies for the continuity of
learning while the school is closed until the local authorities
have determined the safe resumption of face-to-face classes.
TOTAL
FOCUSING ON TEACHING AND LEARNING
I. LEARNING RESOURCES YES NO YES NO YES NO

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1. The school has secured sufficient supply of learning
resources needed for the face-to-face classes.
a. Implementation of 1:1 Student to Self-Learning Module
(SLM) to lessen student interaction during class hours
b. Implementation of 1:1 Student to Textbook ratio to lessen
student interaction during class hours
II. LIMITED FACE TO FACE CLASSES

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1. The school has designed class program/s that cater
both learners of the limited face-to-face classes
arrangement and distance education while observing the
maximum &hour classroom teaching hours of teachers.
a. Arrangement of the number of class sections in a way that
each class section will be able to attend face-to-face classes: o
Class A: Half day face-to-face classes in one straight week and
other half-day for distance learning o Class B: One straight
week of pure distance learning o Classes shall alternately
attend face.to-face classes every week for the whole duration
of the pilot implementation
b. Class program indicating specific schedule/breakdown of
hours for the face-to-face classes including staggered start and
close of the school day per grade level
c. Class program indicating specific schedule/breakdown of
hours for distance learners including staggered start and close
of the school day per grade level
d. Class program indicating schedule of staggered break time
hours
e. Signages on protocols prohibiting activities that require large
gatherings
f. Implementation of the maximum hours of stay of the learners
in schools (4.5 hours for G1-6 learners and 3 hours for
kindergarten learners).

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2. The school has comprehensively profiled learners who
will participate in the implementation of the face-to-face
classes, a. Learners who reside within the city/municipality
where the school/learning center is located
b. Learners who can walk their way to school, or ride with
available private transport, or with regulated public
transportation
c. Learners without existing comorbidities
d. Prioritization of learners who require childcare, such as
those whose parents must work outside the home, or who have
no directly available and immediately responsible adults/
guardians at home

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 Republic of the Philippines
Department of Education
Region IV-A CALABARZON
SCHOOLS DIVISION OF RIZAL
JALAJALA SUB-OFFICE
SIPSIPIN ELEMENTARY SCHOOL
__________________________________________________________________________
e. Prioritization of learners who are heavily dependent on face-
to-face learning interventions, such as Key Stage 1 learners
(Kindergarten to Grade 3)
f. Prioritization of learners who struggle to meet required
learning competencies
g. Prioritization of Senior High School (SHS) learners enrolled
in Technical-Vocational-Livelihood (TVL) track requiring
workshop equipment in school
h. Prioritization of learners that are documented to be affected
by mental health concerns that may be eased by face-to-face
interactions

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3. The school has ensured an attendance monitoring of
learners to determine which participating learners are
exhibiting difficulties in coming to school and which
learners who cannot participate in face-to-face classes will
revert to full distance learning.

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4. The school has informed teachers to conduct
consultations with parents, provision of feedback and
instructional support for learners, facilitation of
assessment, preparation of Weekly Home Learning Plan
(WHLP), and other related tasks after face-to-face classes.

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5. The school has ensured prohibition of conduct of
physical or face-to-face large gatherings, group work or
activities that will require close contact or where physical
distancing may not be possible (e.g., school activities,
field trips, sports festivals, flag ceremonies).
III. TEACHER SUPPORT

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1. The school has provided an appropriate learning and
development support plan in providing better quality basic
education services.
a. Learning and Action Cells (LAC) sessions highlighting
provision of remediation/intervention for learners during the
face-to-face classes
b. Coaching, mentoring, and training relevant in facilitating
blended learning approach

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2. The school has oriented teachers on their budget of
work and ensured that the school requirement for the
learners is in observance of academic ease.
a. Orientation on the implementation of the Most Essential
Learning Competencies (MELCs) included in their budget of
work during the limited face-to-face classes
b. Orientation on the observance of academic ease and
provision of flexibility to learners managing limited face-to-face
classes
TOTAL
WELL-BEING AND PROTECTION
I. PERSONAL PROTECTIVE EQUIPMENT YES NO YES NO YES NO

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1. The school has secured sufficient supply of personal
protective equipment (PPEs) for learners and school
personnel.
a. 1:1 Face mask to Person (daily) ratio
b. 1:1 Face shield to Person ratio
c. 1:1 Toothbrush and Tooth paste to Learner ratio (K-6
learners) d. 1:1 Bar of soap to learner ratio enough for 5x of
hand washing per day (K-6 learners)
e. Availability of emergency health kits that include PPEs and
other needed supplies and materials in the school clinic
f. Availability of PPEs for COVID-19 team members, health

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 Republic of the Philippines
Department of Education
Region IV-A CALABARZON
SCHOOLS DIVISION OF RIZAL
JALAJALA SUB-OFFICE
SIPSIPIN ELEMENTARY SCHOOL
__________________________________________________________________________
personnel and maintenance, and security guards

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2. The school has secured adequate supply of face masks,
face shields, and/or other COVID-l9 protective gears for
learners.
a. 1:1 Replacement of lost and damaged PPE to person ratio

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3. The school has ensured that the available sanitation and
disinfection materials are approved by the Philippine Food
and Drug Administration (FDA) such as:
a. Sodium hypochlorite recommended ratio of 0.1% (1000
ppm) by dissolving % tsp of chlorine or 2 g to 2L of clean water
for regular disinfection, and recommended ratio of 0.5% (5000
ppm) for body fluids by dissolving 1 tbsp. of chlorine or 10 g to
2L of clean water
b. Ethanol in all surfaces at a recommended ratio of 70-90%, or
c. Hydrogen peroxide in all surfaces at a recommended ratio of
>0.5%

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4. The school has secured sufficient supply of disinfection
materials for strategic school locations.
a. 1:1 bottle of hand-sanitizers/alcohol-based disinfectants to
restroom
b. 1:1 bottle of hand-sanitizers/alcohol-based disinfectants to
classroom
c. 1:1 bottle of hand-sanitizers/alcohol-based disinfectants to
entrance/ exit point .

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5. The school has ensured PPE requirements,
specifications, and standards for different types of COVID-
19 management activities in accordance with DOH DM
2020-0776A.
a. Availability of medical mask and face shields for triage and
screening of individuals in points of entry (for personnel in
school entrances)
b. Availability of medical mask, goggles or face shield, gloves,
gown for caring for a suspected case of COVID-19 with no
aerosol-generating procedure (for personnel in school clinics)
c. Availability of respirator (N95 or FFP2), goggles or face
shield, gloves, gown for ca ng for suspected/confirmed cases
of COVID-19 with no aerosol-generating procedure for
personnel in school clinics)
d. Availability of full PPE for assisting in transporting
passengers to a healthcare facility
II. COVID-19 CASE MANAGEMENT

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1. The school has developed strategies to prevent COVID-
19.
a. Conduct of hand hygiene and temperature checks using a
thermal scanner prior to entering the school
b. Prioritization of non-face-to-face communications and
coordination through available platforms and discouragement
of entrance of school visitors and other external stakeholders c.
Conduct of daily rapid health checks in the classroom
d. Conduct of necessary disinfection activities especially in the
areas of the school frequented by personnel or learners that
tested positive
e. Availability of surgical face masks and school clinic for
further assessment of anyone who will show symptoms of
COVID-19
f. Establishment/setting-up/refurbishment of a school clinic to
provide basic health services to all school-goers, such as: o
Health assessment and physical examination, as needed o

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 Republic of the Philippines
Department of Education
Region IV-A CALABARZON
SCHOOLS DIVISION OF RIZAL
JALAJALA SUB-OFFICE
SIPSIPIN ELEMENTARY SCHOOL
__________________________________________________________________________
Appropriate intervention first aid, or treatment o Proper
management of symptoms, including rest at home o Referral
and follow-up of learners, teachers, and personnel to
appropriate facilities
g. Designation of private screening area at the entrance where
schoolgoers who show symptoms upon screening can be
further examined, or referred
h. Designation of separate space where sick school-goers who
have been managed in the clinic can temporarily stay, awaiting
referral to the appropriate health facility, without creating
stigma
i. Designation of clinic teachers(s) in absence of school health
personnel, who shall provide basic health services and
facilitate referral in coordination with the school health
personnel at SDO, in absence of school-based health
personnel j. Orientation to the clinic teacher by the school
health personnel at the SDO for proper guidance on how to
effectively run the school clinic
k. Reiteration of protocols for learners, teachers, and personnel
who IL COVID-l9 CASE MANAGEMENT manifest COVID-19
symptoms to not physically report to school and seek medical
advice virtually if possible Record of students' health status and
development, including immunization checks to prevent
outbreak-prone vaccine-preventable disease (e.g., measles)

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2. The school has identified strategies to detect COVID-19.
a. Cooperation with the local health authorities in the tracing
and quarantine of close contacts of confirmed cases of COVID-
19 consistent with DOH guidelines
b. Presence of the School DRRM Team who shall ensure that
contact tracing activities as required by the local health
authorities, are initiated, and completed among the possible
close contacts among DepEd personnel and learners
c. Close coordination with Epidemiology Surveillance Unit
(ESU) officers per setting o DOH Regional ESU of reporting
school o LGU City ESU/Provincial ESU/Municipal ESU of
reporting school o DOH Regional ESU of identified case (place
of residence) o LGU City ESU/Provincial ESU/Municipal ESU
of identified case (place of residence)
d. Development of a reporting system requiring parents to
report to the school if their children are experiencing flu-like
system, recommendation of testing to be done immediately
with support and guidance from the LGUs
e. Provision of health form to parents/ guardians at the
beginning of each school term confirming their child and/or
family members do not have COVID-19 before being permitted
to go to school to be submitted 24 to 72 hours prior to the start
of school opening

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3. The school has developed strategies to isolate and treat
COVID-19.
a. Designation of rooms for isolation of students and personnel
with fever and flulike symptoms near the entrances b.
Availability of transport vehicles from school to Temporary
Treatment and Monitoring Facility (TTMF)
c. Notification of family member/ guardians of the learner, or
family member of school personnel who show flu-like
symptoms
d. Immediate isolation and referral of the personnel/s or
learner/s who show COVID-19 symptoms based on the

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 Republic of the Philippines
Department of Education
Region IV-A CALABARZON
SCHOOLS DIVISION OF RIZAL
JALAJALA SUB-OFFICE
SIPSIPIN ELEMENTARY SCHOOL
__________________________________________________________________________
severity for proper management and appropriate testing
e. Provision of necessary emergency care to the personnel or
learner following precautionary measures, by the health
personnel or designated clinic teacher
f. Referral/full disclosure of the case to the identified health
authority (e.9., barangay health station, rural health unit) for
further evaluation or referral to a hospital if needed
g. Strict observance of advice from health authorities including
possibility of home quarantine or isolation in a quarantine
facility or confinement
h. Report of the close follow-up of the attending/assigned
school health personnel or designated clinic teacher with the
condition of the identified learner/personnel to the SDO School
health and Nutrition Unit/Section, as required by existing
reporting mechanisms
i. Strict compliance of learner and personnel who have tested
positive for COVID-19 to not return to school without clearance
from medical authorities
j. Monitoring and provision of necessary support of the School
Head (SH) to all cases (close contacts, suspect probable,
confirmed)
k. Coordination of SH to all cases with DepEd school health
personnel and local health authorities
l. Coordination of SH with the SDO in ensuring continuity of
teaching and learning in line with the school's contingency plan
m. Strict observance of provision of Section IV.A (Screening of
Returning Personnel and Learners and Testing Protocol) of the
Specific Measures for COVID-19 Prevention and Mitigation in
Schools (Enclosure No. 2 to DepEd Order No. 014, s. 2020)
before the participation of COVID-19 infected learners or
personnel in the face-to-face classes

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4. The school has developed strategies in providing
psychosocial support to the learners, teachers, and
personnel.
a. Allotment of time and preparation of modules on Mental
Health to be facilitated by their respective classroom advisers
or designated teachers
b. Designation of trained teachers who will facilitate activities
fostering Mental Health such as mental health topics, nature of
COVID-19, and preventive measures (WASH, physical
distancing, etc.)
c. Setting up of an operational Guidance Office that is staffed
by a registered guidance counselor (RGC) or a designated
guidance associate (not an RGC but is trained on MHISS and
is capable of effective referral) every school day, to provide
basic mental health services to learners, teachers, and
personnel who may need such services
d. Availability of a hotline/online platform in the SDOs to
provide counseling services to learners, teachers, and
personnel who require counseling services, in absence of an
RGC
e. Provision of specialized psychosocial support to learners,
teachers and personnel who are confirmed to be positive,
under isolation/ quarantine, and categorized as suspect and
probable, through the Guidance Office using the DRRMS
MHIJSS materials as reference
f. Establishment and contextualization of the inter-sectoral
referral pathways to ensure that psychosocial needs of both

9
 Republic of the Philippines
Department of Education
Region IV-A CALABARZON
SCHOOLS DIVISION OF RIZAL
JALAJALA SUB-OFFICE
SIPSIPIN ELEMENTARY SCHOOL
__________________________________________________________________________
the personnel and the learners are provided
g. Engagement of parents, guardians, or care providers of
learners on taking care of mental health and creating a positive
environment
h. Coordination of mechanisms to ensure that the mental
health and the basic needs of learners and personnel with pre-
existing mental health conditions and special needs including
neurologic and substance abuse disorders such as
medications and other key services are provided
i. Strict adherence to Republic Act No.10173 or the Data
Privacy Act of 2012 in the provision of mental health services
and referral
j. Promotion of "school-life balance" through proper scheduling
of schoolwork that will allow learners to enjoy quality time at
home
k. Mobilization of trained Psychological First Aid (PFA)
providers of the schools to provide necessary mental health
and psychosocial support to concerned personnel or learners

/
5. The school has established a clear procedure of referral
system for COVID-19 confirmed and suspected personnel
and learner.
a. Communication plan which includes coordination system
with LGU for school personnel and learners who show flulike
symptoms
b. Communication plan which includes a referral system for
COVID-19 confirmed and suspected personnel and learners
c. Flow chart of the referral system

/
6. The school has established a clear contact tracing and
quarantine system for close contacts of COVID-19
confirmed positive cases.
a. Communication plan which includes coordination system
with local health authorities in contact tracing and quarantine of
close contacts of confirmed COVID-19 positive cases b.
Communication plan which includes notification of
family/parent(s)/guardian(s) of the concerned learner/s c. Flow
chart of the contact tracing and quarantine system d.
Contingency plan for school lockdown
III. INCLUDING THE MOST MARGINALIZED

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1. The school has identified learners who are most
vulnerable and disadvantaged in terms of access to
learning as indicated in the eligibility of learners, such as
inclusion of:
a. indigent children
b. out-of-school youth
c. physically and mentally handicapped
d. distressed individuals and families, including internally
displaced persons (IDPs)
e. low resourced students
f. abandoned and neglected children
g. street children
h. children of former rebels
i. children living in conflict-affected areas and vulnerable
communities (CVAS)
j. children with disabilities and SPED students
k. children from Geographically Isolated and Disadvantaged
Areas

/
2. The school has identified learners who are most
vulnerable and disadvantaged in terms of access to

10
 Republic of the Philippines
Department of Education
Region IV-A CALABARZON
SCHOOLS DIVISION OF RIZAL
JALAJALA SUB-OFFICE
SIPSIPIN ELEMENTARY SCHOOL
__________________________________________________________________________
learning as indicated in the eligibility of learners, such as
inclusion of:
a. Inclusion of learners who need assistive devices that do not
require them to remove their face masks
b. Coordination with partner agencies in the provision of
assistive devices such as wheelchairs, cane, walkers, and
others
c. Ensured that parent/guardian of learners are informed that
his/her child has their own assistive device during face-to-face
classes

/
3. The school has developed learning strategies to cater
the needs of the marginalized learners such as modules in
braille, mother-tongue languages, and usage of Filipino
Sign Language.

/
4. The school has ensured participation in school-based
services which includes but is not limited to feeding and
nutrition programs, immunizations, Mental Health and
Psychosocial Support (MHPSS), prevention of Violence
against Children (VAC) (i.e., bullying from social stigma)
and other health services

/
5. The school has established close coordination with the
Department of Social Welfare and Development (DSWD)
Case Managers of those learners who are marginalized;
Other partner agencies and organizations such as National
Council on Disability Affairs (NCDA).

/
6. The school has coordinated with their respective local
government units with the implementation of routine
school-based immunization (SBI) and other school health-
related services such as but not limited to deworming and
weekly iron-folate acid supplementation (WIFA).
a. Routine implementation of SBI together with school health
services among target learners
b. Facilitation of the completion of routine immunizations
through regular immunization mechanisms available through
the National Immunization Program (NIP)
c. Routine immunization card checks through the school nurse
or the designated clinic teachers to ensure that children
entering schools have completed their routine immunization
(i.e., 3 doses of Polio and DPT HepaB-Hib vaccines, and two
doses of Measles-containing vaccines) in the community
d. Referral of learners who have not completed their routine
infant vaccines to the nearest LGU/private pediatrician for
catch-up vaccination
e. Participation in intensive health promotion campaigns
activities/supportive-policies that shall be instituted by schools
in collaboration with their local health offices to maintain
optimal health seeking behaviors of learners and other
community member
TOTAL
HOME-SCHOOL COORDINATION
YES NO YES NO YES NO

/
1. The school has developed a plan in coordinating with
the Barangay Local Government Unit (BLGU) or the
Barangay Health Emergency Response Team (BHERT) in
ensuring that protocols are observed properly.
a. Operationalization of the Preventative Alert System in
Schools (PASS) for COVID-19 (per DepEd Memorandum No.
15, s. 2020)

11
 Republic of the Philippines
Department of Education
Region IV-A CALABARZON
SCHOOLS DIVISION OF RIZAL
JALAJALA SUB-OFFICE
SIPSIPIN ELEMENTARY SCHOOL
__________________________________________________________________________

/
2. The school has developed a strategy in orienting
parents on health protocols and safety measures.
a. Safe drop-off and pick-up procedures
b. Safety precautions and preventive measures while
commuting [e.g., wearing of proper face masks and face
shields, refrain from talking and eating while in public
transportation ensure adequate ventilation, frequent and proper
disinfection, appropriate physical distancing
c. Safety precautions and preventive measure upon entering
the school premises

/
3. The school has identified a designated waiting area with
proper ventilation for parent/guardians.
Total
Grand Total
Percentage

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