CHSE DAILY HEALTH
CHECKLIST FOR 1ST
SEMESTER AY 2022-23
ainaangelly.santos@olivarezcollege.edu.ph
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* Required
HEALTH CHECKLIST
State whether you've experienced/are experiencing
the following:
:
*
YES NO
FEVER (For the
past few days)
COUGH
COLDS
SHORTNESS OF
BREATH
PERSISTENT
PAIN IN THE
CHEST
BODY PAINS
HEADACHE
DIARRHEA
SORE THROAT
LOSS OF SMELL
LOSS OF TASTE
:
HAVE YOU WORKED TOGETHER OR STAYED *
IN THE SAME CLOSED ENVIRONMENT OF A
CONFIRMED CoVID-19 CASE?
YES
NO
HAVE YOU HAD ANY CONTACT WITH *
ANYONE WITH FEVER, COUGH, COLDS, AND
SORE THROAT IN THE PAST TWO (2)
WEEKS?
YES
NO
HAVE YOU TRAVELLED TO ANY AREA IN NCR *
ASIDE FROM YOUR HOME?
YES
NO
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