Before you arrive

This short form helps us keep travellers and Ugandans safe from Ebola and other outbreaks. It should take about 2 minutes. Your information is confidential.

Your trip

Port of entry into Uganda Date of arrival Country you are travelling from Countries visited in the past 21 days (comma-separated) Flight or vehicle number (if any)

Days in Uganda

Address while in Uganda

About you

Full name (as on passport)

Date of birth Sex

Nationality Passport or National ID number Phone number while in Uganda Email (optional) Emergency contact phone (optional)

Recent contact

In the past 21 days:

Were you in close contact with anyone who had fever, bleeding, or who later died unexpectedly?

Yes No

Did you attend a funeral or help prepare a body for burial?

Yes No

Did you visit or work in a hospital/clinic in an Ebola-affected area?

Yes No

Did you handle bats, primates, or bushmeat?

Yes No

I declare that the information above is true to the best of my knowledge.