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Students AIHS Contact Tracing Form Template

This document is a contact tracing logsheet from Alfonso Integrated High School in Cavite Province, Philippines. It collects information such as name, address, destination, purpose, contact number, COVID-19 symptoms, and travel history from teachers and students attending classes in Room 303 of the SHS Building on a given date. The logsheet is used to track interactions and monitor for potential COVID-19 exposure in order to limit spread. Information collected includes basic identification, health status, and recent travel to identify high-risk individuals.

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Roscell Reyes
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45 views3 pages

Students AIHS Contact Tracing Form Template

This document is a contact tracing logsheet from Alfonso Integrated High School in Cavite Province, Philippines. It collects information such as name, address, destination, purpose, contact number, COVID-19 symptoms, and travel history from teachers and students attending classes in Room 303 of the SHS Building on a given date. The logsheet is used to track interactions and monitor for potential COVID-19 exposure in order to limit spread. Information collected includes basic identification, health status, and recent travel to identify high-risk individuals.

Uploaded by

Roscell Reyes
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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APPENDIX 3

Republic of the Philippines


Department of Education
REGION IV-A CALABARZON
SCHOOLS DIVISION OFFICE OF CAVITE PROVINCE
ALFONSO INTEGRATED HIGH SCHOOL
ALFONSO, CAVITE

CONTACT TRACING LOGSHEET


(Grade and Section)
Date:
NOTE: PLEASE USE YOUR OWN BALLPEN.

History of travel
within the last 30
Please check if you have any of the following symptoms. days?
(Pakilagyan ng tsek kung nakakaranas ng mga (Ikaw ba ay may TEMPERATURE SIGNATURE

sumusunod na sintomas): pinuntahang lugar


nitong nakaraan na
30 na araw?
NAME ADDRESS DESTINATION PURPOSE CP NUMBER
1 2 3

Difficulty of breathing
If

Headache
Body weakness
Sore throat

Diarrhea
YES Location

Others
Cough
Fever

Colds
Put (Lugar na
check pinuntahan)
Republic of the Philippines
Department of Education
REGION IV-A CALABARZON
SCHOOLS DIVISION OFFICE OF CAVITE PROVINCE
ALFONSO INTEGRATED HIGH SCHOOL
ALFONSO, CAVITE

Teachers
1. SHS Building To attend
Room 303 classes
2. SHS Building To attend
Room 303 classes
3. SHS Building To attend
Room 303 classes
4. SHS Building To attend
Room 303 classes
Republic of the Philippines
Department of Education
REGION IV-A CALABARZON
SCHOOLS DIVISION OFFICE OF CAVITE PROVINCE
ALFONSO INTEGRATED HIGH SCHOOL
ALFONSO, CAVITE

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