REPUBIC OF THE PHILIPPINES

Department of Education

Region VII, Central Visayas

IPHO Building, Sudlon, Lahug, Cebu City

School Name of School Head:

DistrictBARILI II Name of First Aid Teacher:

Checklist for SCHOOL HEADS / FIRST AID TEACHERS on Health Reports Year End Clearance
SY 2018 -2019

Folder - Consolidated Nutritional Status Report (Baseline 2018 - 2019)

1
* Attach supporting documents by Grade Level
Folder - Consolidated Nutritional Status Report (Endline 2018 - 2019)
* Attach supporting documents by Grade Level
Folder - First Dose Deworming Report
* Consolidated by Grade Level
2
* Attach supporting documents by Grade Level (List of pupils - July 2018)
Folder - Second Dose Deworming Report
* Consolidated by Grade Level
* Attach supporting documents by Grade Level (List of pupils - January 2019)
3 Folder - WIFA Administration - Consolidated Report (First Round July - Sept. Female Secondary)
Folder - WIFA Administration - Consolidated Report (Second Round Jan. - March Female Secondary)
4 Folder - SBFP Terminal Report (Elementary)
5 Folder - SBFP Report on Ferrous Sulfate Administration (Wasted / Severely Wasted Beneficiaries)
6 Folder - SBFP Report on Hygiene Kit (Wasted / Severely Wasted Beneficiaries)
7 Folder - SBFP Forns 1, 2, 3 (School Beneficiaries)
Folder - for ASNP Seed Money Report or Revolving Money Report
8
* Supporting documents: Narrative Reports, Cash on Hand, Cash Flow, etc.
Folder - for Applied Nutrition Program of Activities (ANP)
9 * Supplementary Feeding Program by Grade Level: e.g. Menu, Feeding Activities per Month
by Grade Level, Attendance of Parents, Pictorials, etc.
Folder - for Consolidated Visual Acuity Report (June 2018)
10
* Attach supporting documents by Grade Level
Folder - Administrator's Health Supervision Report (Form B - OK sa DepEd)
11 * Basis: Health Assessment Report of the School Nurse (Form 56); Consolidated Visual Acuity Report
Daily Treatment Record in School Clinic, Receipt of Medicines Received, X-ray, Urinalysis, etc.
Folder - for Updated Record of Daily Treatment in School Clinic (New Form) indicating treatment given
12
from June 2018 - March 2019
Folder - for Updated Daily Classroom Health Observation Record or Special List for Teacher by Grade
13
Level indicating Name of Pupils, Ailments/Defects Found, Date Found-Cured, starting June 2018 - March 2019
Folder - Form 86 (Teachers' Health Examination Record) signed by a GOVERNEMNT PHYSICIAN
14
* Attach X-ray / Urinalysis Results. If pregnant, Sputum Examination and Urinalysis Results.
15 Folder - Masterlist of Teaching / Non - Teaching Personnel
16 Folder - for School Health Assessment Report of the School Nurse (Form 56)
17 Folder - for Medicine Supplies Received
18 Folder - for Checklist Handwashing Activities by Grade Level
19 All Health Cards are attached in Form 137 - E by Grade Level
20 Folder - for Dengue Cases Report (January to December 2018) - (January to March 2019)
 21 Folder - for OLY set Net Dengue Control Mosquito (Screened Classroom) Report
22 Folder - for Larviciding Program using Temephos Report
23 Folder - for WiNS Program (Monitoring Data)
24 Folder - for School - Based Feeding Program (SBFP) Report
25 Folder - for Enlistmentof Teaching / NTP to TSEKAP Program / HEALTH PROFILING
26 Health Personnel Logbook
27 School Based Immunization Report: A. Folder for: TT / MR - Grade I & VII
B. Folder for: HPV - Grade IV
C. Folder for: Dengue Vaccine - Grade IV
FINDINGS:
Lacking: 1. ______________________________ 4. ______________________________
2. ______________________________ 5. ______________________________
3. ______________________________ 6. ______________________________
Checked / Evaluated by:

Division Nurse