Get the free Ebola Screening Form - Florida Department of Health

Emergency Department Ebola Virus Disease (END) Screening Tool Version 3.1 (November 18, 2014) Emergency Department screening criteria for patient isolation and notification: 1. Travel to Guinea, Liberia,

How to fill out ebola screening form

How to fill out an Ebola screening form:

1. Start by carefully reading all the instructions provided on the form. Make sure you understand each section and the information required.
2. Begin filling out the personal information section. This may include your full name, date of birth, gender, and contact information. Provide accurate and up-to-date details.
3. Move on to the travel history section. List all the countries you have visited in the specified time frame, including layovers or transit countries. Include the dates of travel and any specific regions you may have visited within each country.
4. Provide details about your health status. Answer questions related to any symptoms you may have experienced such as fever, cough, difficulty breathing, or any other relevant symptom mentioned on the form.
5. If applicable, disclose any known close contact with individuals who have been diagnosed with Ebola or any other infectious disease. Include dates and the nature of the contact.
6. Complete any additional sections or questions on the form, such as providing information about your occupation, purpose of travel, or any other relevant details.
7. Review your filled-out form to ensure all information is accurate and complete. Double-check for any errors or missing information.
8. Submit the form as per the instructions provided. This may involve handing it over to a designated official, mailing it to a specified address, or submitting it electronically through an online platform.

Who needs an Ebola screening form?

1. Individuals traveling to or from countries or regions affected by Ebola may be required to fill out an Ebola screening form. This includes both citizens and foreign nationals.
2. Healthcare workers, first responders, and individuals involved in the management or control of infectious diseases may also be required to complete an Ebola screening form as part of their job responsibilities.
3. Vessel and aircraft crew members may be mandated to fill out the form as they frequently come into contact with individuals who have traveled to high-risk areas.
4. Depending on the specific regulations and guidelines set by different countries or organizations, there may be variations in who needs to fill out an Ebola screening form. It is essential to follow the instructions provided by the relevant authorities in each specific case.

For pdfFiller’s FAQs

What is ebola screening form?

Ebola screening form is a document designed to assess a person's risk of exposure to the Ebola virus.

Who is required to file ebola screening form?

Individuals traveling from or to regions known to have cases of Ebola are required to file the ebola screening form.

How to fill out ebola screening form?

To fill out the ebola screening form, individuals must provide information about their travel history, contact with Ebola patients, and any symptoms they may be experiencing.

What is the purpose of ebola screening form?

The purpose of the ebola screening form is to prevent the spread of the Ebola virus by identifying individuals who may have been exposed to the virus.

What information must be reported on ebola screening form?

Information such as travel history, contact with Ebola patients, and any symptoms must be reported on the ebola screening form.

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