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# DLA Official Forms

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Form Information
| Form Number:       | DLA7012                                                                                                                                                                                             |
|--------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Form Title:        | Ebola Post-Exposure Symptom Diary                                                                                                                                                                   |
| Form Version:      | Canceled                                                                                                                                                                                            |
| Status:            | Canceled                                                                                                                                                                                            |
| Functional Area:   | Installation Management                                                                                                                                                                             |
| Opr:               | DM                                                                                                                                                                                                  |
| Safeguards:        | PAS, PII                                                                                                                                                                                            |
| Electronic:        | Yes                                                                                                                                                                                                 |
| Form Link:         | |options=W                                                                                                                                                                                          |
| Type:              | Primary                                                                                                                                                                                             |
| Prescribed:        | Pre-deployment, Deployment, and Post-deployment Training, Screening, and Monitoring Guidance for Department of Defense Personnel Deployed to Ebola Outbreak Areas. Dated October 10, 2014.          |
| Description:       | THIS FORM IS CANCELED AS A RESULT OF THE 2020 FORMS SURVEY ON DLA-LEVEL FORMS.  Form was be used to document the monitoring of symptoms for returning deployed DLA civilian and military personnel. |
| Records Retention: | 162.40 Employee Medical File (GRS 1, Item 21)                                                                                                                                                       |
| Form Audience:     |                                                                                                                                                                                                     |

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