Fever Monitoring Chart: Morning (Am) And Evening (Pm) For 21 Day (Page 2 of 2) in pdf

Instructions for the Fever Monitoring Chart

1.) Name: Fill in your First name, Middle Initial, and Last name.

2.) Self-Reported vs. Public Health Observed Checkbox: If you are fever monitoring yourself, check the “Self-Reporting” box. If Public Health

employees are performing fever monitoring for you, check the “Public Health Observed” box.

3.) Date Left Ebola-Impacted Country: Fill in the date (DD/MM/YY) you left the Ebola-impacted country.

4.) Date Returned to the United States: Fill in the date (DD/MM/YY) you returned to the United States.

5.) Date: Fill in the date (DD/MM/YY) you perform your fever and symptom monitoring in the appropriate row and column. “Day 1” = the day

you left the Ebola-impacted country. If you did not begin your fever monitoring on “Day 1”, begin recording on the appropriate “Day #”

column.

6.) Time of Check: Fill in the time you perform your AM and PM fever checks in the appropriate row and column.

Recording Temperature and Symptoms

7.) Temperature: Take your oral temperature in the morning (AM) and in the evening (PM) and record the numeric value in degrees

Fahrenheit in the appropriate row and column. Morning (AM) and evening (PM) temperatures must be taken at least 8 hours apart.

8.) For all other symptoms, including severe headache, muscle/joint aches, vomiting, diarrhea, stomach pain, bleeding or bruising, and

fatigue/weakness: please mark either “Y” for Yes if you have the symptom or “N” for No if you do not have the symptom. Do not leave any

spaces blank.

9.) Fever-Reducer Taken?” Mark “Y” for Yes if you have taken a fever-reducing medication in the past 12 hours and “N” for No if you have not

taken a fever-reducing medication in the past 12 hours. Avoid using fever-reducing medications (Ibuprofen, Motrin, Aleve, Aspirin, Tylenol,

Acetaminophen and Naproxen sodium) during the 21-day monitoring period.

If you have a fever > 101.5°F (38.6°C) or have any signs or symptoms of Ebola, call Public Health

immediately at (813) 307-8000 and do not leave your home or travel anywhere. If you are sick, limit

contact with other household members.

Date Created: October 3, 2014

Fever Monitoring Chart: Morning (Am) And Evening (Pm) For 21 Day Page 2