Fever Monitoring Chart: Morning (Am) And Evening (Pm) For 21 Day printable pdf download

Fever Monitoring Chart: Morning (Am) And Evening (Pm) For 21 Day

Fever Monitoring Chart: Morning (AM) and Evening (PM) for 21 days

 Self-Reported  Public Health Observed

Name:_______________________________________________

Date Left Ebola-Impacted Country:________________________

Date Returned to the United States:________________________

Day:

Day 1

Day 2

Day 3

Day 4

Day 5

Day 6

Day 7

Day 8

Day 9

Day 10

Date:

Time of Check:

Symptoms

Temperature (°F)

Severe headache

Muscle/Joint aches

Vomiting or Diarrhea

Stomach pain

Bleeding or bruising

Fatigue/Weakness

Fever reducer taken?

Day:

Day 11

Day 12

Day 13

Day 14

Day 15

Day 16

Day 17

Day 18

Day 19

Day 20

Day 21

Date:

Time of Check:

Symptoms

Temperature (°F)

Severe headache

Muscle/Joint aches

Vomiting or Diarrhea

Stomach pain

Bleeding or bruising

Fatigue/Weakness

Fever reducer taken?



If you have a fever > 101.5°F (38.6°C) or have any symptoms of Ebola, call Public Health immediately at (813) 307-8000. Do not leave your home or travel anywhere.



If you are sick, limit contact with other household members.



Avoid using fever-reducing medications (Ibuprofen, Motrin, Aleve, Aspirin, Tylenol, Acetominophen, Naproxen sodium) during the 21-day monitoring period.



Morning (AM) and Evening (PM) temperatures must be taken at least 8 hours apart.

Date Created: October 3, 2014