EVD Self reporting form
This form is for people who travelled in Guinea and Cote D'Ivoire During last 21 days it will be completed twice a day during 21 days .

*Obligatoire




Do you have any of the following EVD signs ?
select yes if you have any of the symptom


   Yes No
   Yes No
   Yes No
   Yes No
   Yes No
   Yes No
   Yes No
   Yes No
   Yes No
   Yes No