Republic of the Philippines
Department of Health
Cagayan Valley Center for Health Development
ENVIRONMENTAL AND OCCUPATIONAL HEALTH
MONITORING CHECKLIST
Municipality:_________________________________ Province:____________________________
Total No. Of Population:________________________
Total Households:_____________________________
Date of Monitoring:____________________________
Accomplishment
Activities Target Remarks
Number %
Households with Access to Safe
Water Water
Level I( Point Sure)
Level II(Commununal Stand Post)
Level III (Water Works)
Households using Safely managed
drinking water services.
Number of Water Refilling Stations
Number of Water Refilling Stations
with Sanitary Permits
Number of Water Refilling Stations
with Operational Permit
Number of Renewed Water Refilling
Stations with Operational Permit
Household with Basic Sanitation
Waste Management Facilities
Household with Satisfactory
Disposal of Solid Waste
Household with Safely Managed
Sanitation Facilities
Number of Food Establishments
Food
Number of Food Establishments
with Sanitary Permit
Food Handlers With Health
Certificate
Number of Public Places Inspected
Public Places
Public Places Issued with Sanitary
Permit
Number of Barangays verified and
certified with Zero Open Defecation
Zero Open (ZOD) Status
Defecation
LHSD-SOP-01-Form4Rev.2
Monitored by:
_________________
_________________
______
