Monitoring Form BHL 062420

Picture showing properly wearing of face mask, face shield or PPE (if frontliner) and undergoing foot disinfection.
Picture of showing observance of one (1) meter physical distancing.

Picture showing wearing of face mask, face shield or PPE (if frontliner) and observing 1 meter physical distancing.
Picture showing disinfection of workstation, equipments, etc.:
Picture of Health DecPicture of Health Declarat Picture of Health Declarat Picture of Health Declarat
Note: ngpadeclare po ako ngayon kasi ngayon lng po kame ngsimula ng monitoring
Timestamp Surname First Name Middle Name
6/22/2020 0:00:00 Maniebo Neill B.
6/22/2020 0:00:00 Cabiguin Vilma C.
6/22/2020 0:00:00 Campo Elvin C.
6/22/2020 0:00:00 Mendoza Cecilia A.
6/22/2020 0:00:00 Mendoza Obte B.
6/22/2020 0:00:00 Morada Marlon A.
6/22/2020 0:00:00 Mendoza Jeffrey M.
6/22/2020 0:00:00 Escala Riza J D.
6/22/2020 0:00:00 Guinacaran Jardine K.
Picture of Health Declarat Picture of Health Declarat Picture of Health Declarat Picture of Health Declarat
Residential Address Contact Number Age Gender

Brgy. Balintawak Lipa Bat 9270525830 34 Male
Pagadian City 9091850933 46 Female
Usab, Masbate City 9466138247 26 Male
San Benito, Lipa City 9057395674 36.5 Female
Brgy. Balintawak Lipa Bat 9287068507 36.5 Male
Brgy. Balintawak Lipa Bat 9104154350 36.5 Male
Brixton Homes, Brgy. Balin 9338513113 36.2 Male
Barangay 4, Mataasnakaho 9338687655 35 Female
Brgy. San Isidro San Luis 9753724237 37 Male
Area Department Body Temperature AM 1.Nagpunta ka ba sa ospita

BHL Security 36.5 HINDI
BHL Security 36 HINDI
BHL/SVL/AVL Engineering 36.2 HINDI
BHL HRCD 36.1 HINDI
BHL Engineering HINDI
2.Sa nakalipas na 2 linggo 3. Sa nakalipas na 2 lingg 4.Sa nakalipas na 2 linggo 5.Ikaw ba ay na-identify na
HINDI HINDI HINDI HINDI
Picture of Health Declarat Picture of Health Declaration Form Summary (Excel FilPicture of Health Declarat
6. Sa nakalipas na 2 lingg 7. Ikaw ba ay nagpunta sa 8. Ikaw ba ay nagpunta sa 9.Mayroon ka bang sakit/me

HINDI OO (Lemery, Batangas) HINDI HINDI
HINDI oo (Lipa City) HINDI HINDI
10. Ako ay senior citizen Pinatutunayan ko na ang mg

Alinsunod din sa Republic Dahil dito, nabasa, naunaw
HINDI OO OO OO
HINDI OO OO OO
HINDI OO OO OO
HINDI OO OO OO
HINDI OO OO OO
HINDI OO OO OO
HINDI OO OO OO
HINDI OO OO OO
HINDI OO OO OO
Email Address
Picture of Health Picture of Health Picture of Health Picture of Health Picture of Health Picture of Health
Picture of Health Picture of Health
Picture of Visitors Logsheet or Paste here the excel file of the visitors log sheet
Paalala kung wala pong dumating na visitor sa araw na ito sa inyong nasasakupan, mangyari lamang pong lagyan itong sheet
Kapag "NO VISITOR TODAY" ay hindi na kailangan picturan ang Visitor Log Sheet at i-insert dito.
mang pong lagyan itong sheet na ito ng "NO VISITOR TODAY".
Disinfection Checklist
Pwede din pong i-insert dito ang picture ng Disinfection Checklist
Company Name : Date: 26-Jun-20

Health and Safety In Charge : Riza J D. Escala
Location : Brixton Homes- Lipa City, Batangas
Contact Number : 09338687655
Area: Subdivison Office / ClubHouse Engineering Office Barracks
m
m
am
0a
p
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Duties
11
9:
7:
1:
3:
4:
7:
Entrance
Clean / Sanitize Entrance √ √ √ √ √
Clean / Sanitize Foot Bath √ √ √ √ √
Refill Alchohol Container √ √
Refill Foot Bath Solution √ √ √ √ √
Hallway
Disinfect / Sanitize Hallways √ √ √ √ √
Sweep / Mop Floor Tiles √ √ √ √ √
Office Area / Meeting Rooms
Clean / Sanitize Area √ √ √ √ √
Arrange Chairs √ √ √ √ √
Clean Window Blinds
Clean / Polish Glass Partitions
Pantry
Check / Replace Water Dispencer
Defrost Refrigerator
Clean Kitchen Counter, Sink and Tables √ √ √ √ √
Clean Microwave Oven
Replenish Soap
Utility
Replace Busted Lights
Plumbing
Clean / Sanitize Restroom √ √ √ √ √
Others
Waste Segregation
Waste Disposal √ √ √ √ √
*Sign on Indicated Days when checked / performed task
Remarks:
Processed By: Checked By:

Jardine Guinacaran Riza J D. Escala
Skilled Subdivision Admin
Daily Monitoring Report (Summary of COVID-19)
Pwede din pong i-insert dito ang picture ng Daily Monitoring Report
APEC HOMES
Ka-APEC Kontra COVID-19
Daily Monitoring Report
Date 26-Jun-20
Site / Location Bixton Homes Lipa
A. Checklist before entering office and site: (For strict observation and compliance) %
1. Submittal of picture showing wearing of face mask, face shield or PPE (if frontliner) and undergoing foot disinfection. 100.00
2. Submittal of picture of showing observance of one (1) meter physical distancing. 100.00
B. Checklist while inside the office and site: (For strict observance and compliance)
1. Submittal of picture showing wearing of face mask, face shield or PPE (if frontliner) and observing 1 meter physical distancing. 100.00
2. Submittal of picture showing disinfection of workstation, equipments, etc.: 100.00
C. Checklist before leaving the office: For strict observance and compliance)
1. Submittal of Health Declaration Form Summary (Excel File) 100.00
2. Submittal of Visitors Logsheet 100.00
3. Submittal of Disinfection Checklist 100.00
4. Submittal of Daily Monitoring Report 100.00
Over-all score 100.00

Summary of COVID-19:
Suspect (PUI) 0
Probable (PUM): 0
Confirmed
Suspect (PUI) - Having Influenza0 Like Ilness (ILI)
(Positive):
A. Fever above 38 C, Cough or sore throat, exposed to a probable or confirmed case within 14 days since initial manifestation of symptom, Living in an area wi
confirmed
Legend: local transmission, travel history to countries with reported COVUD-19 transmission.
B. Sudden symptoms of Severe Acute Respiratory Infection (SARI) with need for hospitalization.
C. ILI or SIRI symptom, with no confirmed test result and are at risk individual such as: age 60 and above, high risk pregnancy, health worker
Probable (PUM) - Inconclusive COVID-19 test result (Make sure that your test is conducted in a government-certified laboratory to ensure the legitimacy of the result.
Confirmed (Positive) - Covid-19 tesr result was condcuted in a government-certified laboratory and received a positive result
Remarks:
All Personnel written in the Summary are Covid-19 Free and Healthy.
BHL is Covid-19 Free
Prepared by:
Riza J D. Escala
Health and Safety In-charge
Compliant Remarks
1
1
1
1
1
1
1
1
f symptom, Living in an area with
h risk pregnancy, health worker.

ure the legitimacy of the result.
Health and Safety Checklist
Pwede din pong i-insert dito ang picture ng Daily Monitoring Report
APECHOMES KONTRA COVID 19

Health & Safety Checklist
Date: 26-Jun-20
Site / Location: Bixton Homes Lipa
A. Checklist before opening of office / site: (For strict observation and compliance)
1. Office disinfection [ / ]
2. Print out / hard copy of Online Health Declaration Form and Visitors Log Sheet [ / ]
3. From the OHD form, identify persons that are not allowed to enter [ / ]
a. 21 years old below
b. 60 years old above
c. Pregnant
d. With health risk
4. One (1) meter physical / social distancing before entering the office / site [ / ]
a. Check markers / signages on seats, floors and walls if placed and placed properly
5. Check the thermal scanner, Alcohol dispenser and disinfection foot mat [ / ]
B. Before entry of employees / partners to the office / site: (For strict observation and compliance) [ / ]
1. Double check the print out Health Decaration Response Summary / hard copy of OHD form [ / ]
2. Supervise the checking of body temperature and alcohol spray on hands [ / ]
3. Supervise and advise every person to step on disinfecting mat [ / ]
4. Advise employees to use face detection biometrics [ / ]
a. If face detection is not availble, sanitize hands before and after using finger biometrics
5. Remind everyone of one (1) meter physical / social distancing [ / ]
C. During working hours: (For strict observation and compliance) [ / ]

1. Monitor and supervise utility personnel doing disinfection checklist every 2 hours [ / ]
2. Conduct the 2nd body temperature checking and log at the Health Declaration form response summary (a [ / ]
3. Checking of facemask if wearing and properly wearing. [ / ]
4. Observing if one (1) meter physical / social distancing is being observe [ / ]
D. Before closing the office / site: (For strict observation and compliance) [ / ]
1. Office disinfection (See Disinfection Checklist) [ / ]
2. Submission of reports to the Central Planning and Monitoring (cut off time at 7pm of the same day) [ / ]
Prepared by:
Riza J D. Escala
Health and Safety In-Charge

Monitoring Form BHL 062420

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Monitoring Form BHL 062420

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Verfügbare Formate

Picture showing properly wearing of face mask, face shield or PPE (if frontliner) and undergoing foot disinfection.

Picture of showing observance of one (1) meter physical distancing.

Residential Address Contact Number Age Gender

Area Department Body Temperature AM 1.Nagpunta ka ba sa ospita

6. Sa nakalipas na 2 lingg 7. Ikaw ba ay nagpunta sa 8. Ikaw ba ay nagpunta sa 9.Mayroon ka bang sakit/me

10. Ako ay senior citizen Pinatutunayan ko na ang mg

Company Name : Date: 26-Jun-20

Area: Subdivison Office / ClubHouse Engineering Office Barracks

*Sign on Indicated Days when checked / performed task

Processed By: Checked By:

Over-all score 100.00

f symptom, Living in an area with

h risk pregnancy, health worker.

APECHOMES KONTRA COVID 19

C. During working hours: (For strict observation and compliance) [ / ]

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