EVD Monitoring Log Form
Use this form to record daily Ebola Virus Disease (EVD) monitoring activity in workplace or field operations. Please complete all relevant fields for each monitoring instance.
Date of Monitoring
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Monitored Person's Full Name
*
First Name
Last Name
Location of Monitoring
*
Temperature (°C)
*
Symptoms Present
Fever
Headache
Fatigue
Muscle Pain
Sore Throat
Vomiting
Diarrhea
Other
Contact Number (Optional)
Please enter a valid phone number.
Format: (000) 000-0000.
Monitoring Staff Name
*
First Name
Last Name
Additional Notes
Submit Log
Should be Empty: