Weekly Active Monitoring Report - word

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Weekly Monitoring Report Template

Low Risk
Some Risk
High Risk

Travelers
US healthcare workers
Other
low risk


Number of persons required to be monitored at any time during the reporting period





Number of persons required to be under monitoring on the first day (Monday) of the reporting period





Number of persons who were added to those requiring monitoring at any time during the reporting period





Number of persons who  completed their 21 days of monitoring during the reporting period





Number of persons who were being monitored but were  transferred to another U.S. jurisdiction  for monitoring during the reporting period





Number of persons who were being monitored but left the U.S. during the reporting period





Number of persons with whom  initial contact was never established  (i.e. missing or incorrect contact information; unable to contact) during the reporting period





Number of persons who were reported as "no initial contact" in a previous reporting period but were found during this reporting period





Number of persons who were lost to follow up at any time during the reporting period (i.e. did not report for 48 hours or longer)





Number of persons who were reported as "lost to follow up" but were found during this reporting period





Number of persons who reported fever and/or other compatible Ebola symptoms (severe headache, muscle pain, weakness, diarrhea, vomiting, stomach pain, or unexplained bleeding or bruising) during the reporting period





Number of persons under monitoring who were laboratory tested for EVD during the reporting period





Number of persons under monitoring who became laboratory-confirmed cases of EVD during the reporting period






Submit weekly reports at:   http://phprsurveys.cdc.gov/mrIWeb/mrIWeb.dll?I.Project=WEEKLYREPORT_V2_LOWEBOLARISKEXPOSURE