GHI Malaria ExxonMobil AppendixA

ExxonMobil Malaria Control Program
Generic Malaria Control Program
Page 1 of 44
Revision: 2 Issued: March 2002 Exxon Mobil Corporation
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Table of Contents
1.0 Introduction.................................................................................................................4
1.1 Introduction .........................................................................................................4
1.2 Purpose ..............................................................................................................4
1.3 Scope..................................................................................................................4
1.4 Users ..................................................................................................................4
2.0 Procedure for Developing Location Specific Malaria Control Program ....................5
2.0 Procedure for Developing Location Specific Malaria Control Program.............5
2.1 Implementation Tools .........................................................................................5
2.2 Implementation Steps.........................................................................................7
3.0 Malaria Elements of ExxonMobil Travel Health Program .........................................12
3.1 Travel Health Elements ......................................................................................12
3.1.1 ExxonMobil Travel Health Clinic ...............................................................12
3.1.2 ExxonMobil Travel Services......................................................................12
3.1.3 Employees .................................................................................................12
4.0 Internal Malaria Control Program Stewardship .........................................................13
4.1 Objectives .........................................................................................................14
4.2 Notification / Reporting......................................................................................14
4.3 Malaria Chemoprophylaxis Compliance Program ...........................................14
Generic Malaria Control Template ...............................................................................16
1.0 Introduction.................................................................................................................17
1.0 Introduction .........................................................................................................17
1.1 Purpose ..............................................................................................................17
1.2 Scope..................................................................................................................17
1.3 Identification of Risks .........................................................................................18
1.4 Users ..................................................................................................................18
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2.0 Procedures.................................................................................................................19
2.1 Introduction .........................................................................................................19
2.2 Detailed Procedures ...........................................................................................19
2.3 Environmental Vector Control ............................................................................19
3.0 Program Execution Resources ..................................................................................19
3.1 Lead Country Manager.......................................................................................20
3.2 Business Line Management...............................................................................20
3.3 In-Country MOH..................................................................................................20
3.4 Malaria Control Officer (MCO) / SHE .................................................................20
3.5 Employee............................................................................................................20
3.6 In-Country Preferred Medical Provider ..............................................................20
4.0 Verification and Measurement...................................................................................22
Table 1: Malaria Control Program Execution Plan ..........................................................23

Table 2: Environmental Vector Control Plan ...................................................................25
Appendices
Appendix 1: Malaria Questionnaire................................................................................28
Appendix 2: Worker Education ......................................................................................29
Appendix 3: Post Travel Handouts ................................................................................32
Appendix 4: Malaria Chemoprophylaxis ........................................................................33
Appendix 5: Malaria Immunity .......................................................................................34
Appendix 6: Personal Protection ...................................................................................37
Appendix 7: Vector Control Measures...........................................................................38
Appendix 8: Malaria Diagnosis and Treatment .............................................................39
Appendix 9: Verification, Measurement, Inspections and Audits..................................40
Appendix 10: Malaria Case Investigation Form ..............................................................41
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1.0 Introduction
1.1 Introduction
Malaria is one of the most serious world health problems of the 21st century.
Approximately 300-500 million of the world’s people are infected by the disease and
between 1.5 to 2.7 million die from it every year.
Malaria risks exist in over one hundred countries and territories. Previously widespread,
the risk is now confined primarily, but not exclusively, to the lesser-developed tropical
areas of Africa, Asia and Latin America. The problems of controlling malaria in these
countries are aggravated by inadequate health structures and poor socioeconomic
conditions. The situation has become even more complex with the increase in
resistance to the drugs used to treat the disease.
Malaria represents a significant health risk in many areas where ExxonMobil operations
are being carried out. Until such time that malaria can be controlled at the community
level, it is important that Company control programs be established to protect personnel
and Company’s operations.
1.2 Purpose
This procedure provides guidelines and information for the control of malaria through
internal site specific malaria control programs and travel health support.
1.3 Scope
The Malaria Control Program (MCP) is applicable to all ExxonMobil personnel and their
dependents, who travel to or reside in locations where malaria is known to be a
significant health risk. Non-immune employees and their dependents, e.g. expatriates,
business travelers, etc. will be involved in all aspects of the MCP when traveling to or
residing in malaria endemic areas. Semi-immune employees, who may have achieved
some immunity due to long-term residence and repeated exposure to the malaria
parasite, will benefit from the program interventions that are not detrimental to their
health.
Contractors working in malarious areas on behalf of ExxonMobil, are expected to protect

their employees through the development and implementation of a malaria control
program, which should be consistent with ExxonMobil Malaria Control Program
recommendations.
1.4 Users
Operations management, MOH, Malaria Control Officer (MCO), SHE contacts, MOH
1.0 Introduction Page 4 of 44

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2.0 Procedure for Developing Location Specific Malaria Control Programs
This procedure provides step-by-step guidelines for developing a site-specific malaria

control program, using standard implementation tools and the Generic Malaria Control
Program Template
2.1 Implementation tools
A number of useful reference documents, procedures, forms and training aids are available
to assist with MCP implementation. These materials have been placed into a “Toolbox”,
which is accessible through the Corporate Safety, Health and Environment (SHE) intranet
home page.
The tools include, but are not limited to the following:
Hazard Identification and Risk Assessment
• Malaria Risk Maps

• Malaria Risk matrix
• Public Health Risk Assessment Procedure
Procedure implementation
• ExxonMobil Internal Malaria Control Program

• Generic Malaria Control Program Template
• MCP Execution Table
• Environmental Vector Control Table
• Contract Language Clause
• Generic Scope of Services for Contract Medical Providers
Training
• Procedure for Implementing Health Orientation Training

• Generic Health Orientation Training module
• Malaria Brochure
• Malaria Video

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Incident Investigation
• Malaria Case Investigation Form

• Upstream Incident Investigation and Analysis
Performance Monitoring
• Procedure for Implementing a Health Reporting System (HRS)

• HRS Instruction Manual
• HRS Intake Forms
• Health Inspection Guidelines for Upstream Operations
• JOBS Safety Observation Program for Malaria Prevention
• JOBS Cards
• Generic MCP Stewardship Matrix
Implementation Issues (FAQ)
The MCP Toolkit and associated links will be kept up to date and will be the primary source of
ongoing implementation information. Hardcopies of the information will not be centrally
distributed due to the potential difficulties involved with ensuring that all locations have the
most up to date information

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2.2 Implementation Steps
Steps Remarks
1 Verify the need for a site-specific Refer to site specific Public Health Risk
malaria control program based on Assessment and malaria risk matrix and
MOH recommendations. maps on the intranet tool box.
2 Designate a local Malaria Control The MCO is designated by line management
Officer(MCO) to implement the MCP. The MCO may come
from any part of the operating organization
but must become thoroughly familiar with the
elements of the MCP and understand the
basics of malaria transmission and
prevention, including vector control. The
MCO should engage in-country SHE and
MOH resources to assist in MCP
implementation.
3 Develop procedure for All personnel must have access too mosquito
supplying/applying insect repellent when needed or requested. For
repellents, laundry insecticide and detailed information on recommended
bed nets to all personnel. mosquito repellent, see Appendix 6 .
Employees who launder their own clothing

must be provided with insecticide and
instructions for treating their outer clothes .
Provisions must be in place to accommodate
insecticide treating of clothing belonging to
visitors and rotators.
For detailed information on insecticides and
treatment, See Appendix 6 .
Bed nets must be provided in all non-
mosquito-proof quarters. See Appendix 6 .
4 Develop procedures for the use of A malaria questionnaire must be completed

Malaria Questionnaire and by first-time visitors, rotators, expatriates and
departure handouts. dependents upon arrival. See
(Appendix 1). The purpose of the
questionnaire is to confirm the person’s
preparedness for working and/or living in a
malarious location and to complement any
lack of awareness training and/or self
protection supplies.
Upon departure, all expatriate employees and

dependents, visitors, and rotators must be
provided with the departure malaria material in
Appendix 3.

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5 Evaluate each facility (e.g., All company-controlled facilities must be

private residences, staff houses, made as insect proof as possible. The
hotels, camps, warehouses, field evaluation process should include an initial
facilities, office buildings, etc.) to inspection and related corrective actions.
determine which environmental
vector control measures (as
described in (Table 2) are The required control measures for each facility
applicable. must be documented as shown in the example
in Table 2.
Develop a local environmental − Periodic inspections
vector control plan. − Breeding site control
− Outdoor Residual Spraying
− Indoor insecticides
− Outdoor spraying/Fogging
6 Develop procedure for providing General information on malaria prophylaxis is

chemoprophylaxis to non-immune provided in Appendix 4.
personnel and dependants.
The local malaria control program shall
Malaria prophylaxis is not support the chemoprophylaxis regimen
recommended for semi-immune recommended by MOH by:
employees. See (Appendix 4) ß Ensuring preferred medical providers
follow ExxonMobil recommended regimen
of chemoprophylaxis and have adequate
supplies on hand.
Malaria chemoprophylaxis and treatment
drugs must only be distributed through
medical providers.
7 Develop procedure for ensuring Preferred medical providers shall follow
prompt access to rapid diagnosis ExxonMobil protocol for rapid diagnosis and
and treatment of malaria. treatment. See ( Appendix 8)
in accordance with the
Scope of Services Agreement specifications.

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8 Develop procedures for malaria Each location shall be responsible for

awareness training of employees, developing an initial and ongoing training
dependants, rotators, and visitors program. Training shall include information
on malaria transmission, prevention, and
treatment .
Initial training shall be provided to new

employees and expatriate dependents, and
first time visitors and rotators, upon arrival or
at the start of their assignment. A copy of the
Malaria Brochure and the Malaria Video shall
be available for use during this training.
Examples of ongoing training may include:

• Circulation of notices with reminders about
importance of personal protection
measures, behavior, and
chemoprophylaxis.
• Periodic surveying of employees to keep
their awareness levels high.
• Ongoing display of education materials
such as posters, leaflets.
• Availability of audio-video materials.
• Display of local malaria statistics, (the
number of malaria cases and/or the
number of days without a malaria case) in
highly-visible locations.
• Inclusion of malaria training and
discussions in safety meetings.
9 Develop procedure for Each location shall integrate the malaria Case
investigation of malaria cases Investigation Form attached (Appendix 10),
into the standard Incident Investigation
Procedure. Every case of malaria occurring in
non-immune employee should be investigated
promptly MOH & SHE representatives
10 Develop procedure to ensure Contractors doing work on ExxonMobil behalf

contractors meet ExxonMobil must, at a minimum, be aware of the
standards for malaria control ExxonMobil standards for malaria control and
protect their employees accordingly.
• Amend existing service ExxonMobil Procurement will ensure that the
contracts to include Malaria Health and Safety Contract clause includes
Prevention Clause malaria prevention requirements for
contractors as follows:
• Ensure Malaria Prevention
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Clause is included in all new Malaria Prevention Clause:

contracts “Where ExxonMobil has determined malaria
to be a significant health risk for operations,
Contractor shall develop and implement a
site-specific plan for the control of malaria for
its employees and subcontractor, both non-
immune and partially immune. Such a plan
should include: awareness and education;
bite prevention; chemoprophylaxis (where
applicable); and early diagnosis and early
treatment. It is the Contractor’s responsibility
to notify its employees and subcontractors
whom are resident in a malaria area or
planning to travel to such an area (in advance
of travel), in order to take necessary actions
including any required chemoprophylaxis. For
reference, a copy of ExxonMobil’s Malaria
Control Program will be provided upon
request as a guide in developing Contractor’s
plan. ExxonMobil reserves the right to review
Contractor’s plan and actual implementation
measures.”
11 Develop procedures for collecting Examples of verification measures include:

data to verify program activities
+PMP scope of service requirements reflect
are being conducted
generic program requirements for prevention
and treatment
+There is a written site-specific malaria control
program, including the site-specific tables,
which have been communicated to all
participants.
+Contract documents are amended to reflect
malaria control expectations.
+Malaria training is integrated into local
training program.
+ Number and percentage of employees,
rotators, and visitors having received health
orientation.
Each site should consider using the

Upstream Health Inspection Guidelines
for program verification Measurement
See Appendix 9 for additional
considerations.

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12 Develop procedure for tracking The MCO shall collect and report to line
trends in malaria. management the following measurement data
monthly
ß Number of cases of malaria in non-immune

population (visitors, rotators, employees
and dependents)
• Number of lost days for national
employees due to malaria
ch site should consider using the Health
Reporting System (HRS) for tracking trends in
malaria.
13 Implement Safety Observation Refer to JOB OBservation Program

Program for Malaria Prevention (Optional Implementation Tool)
where applicable
14 Customize Generic Malaria Data required for customization:
Control Program Template,
with site-specific data and • Insert unit name and locations
requirements • Insert other site-specific users (section 1.4)
• Insert location risk data (section 1.3)
• Complete Tables 1 & Table 2
• Modify Roles and Responsibilities (section
3.0)
Insert verification measures and periodicity of
review (section 4.0)
15 Provide training to the users of Potential users are Security, Procurement,
the site-specific procedure General Services etc...

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3.0 Malaria Elements of ExxonMobil Travel Health Program

An important element of the Malaria Control program is the pre-travel preparation for employees
and communication of malaria risks.
3.1 Travel Health Program Elements
3.1.1 ExxonMobil Travel Health Clinic
• Travel health consultants must be knowledgeable in malaria prevention and

treatment and familiar with company's standard for malaria protection including
proper regimens for chemoprophylaxis, and personal prevention measures.
• Travel health clinics must have access and utilize the malaria risk matrix and the
Travax database for identification of malaria risks locations
• Travel health clinics must have a supply of malaria brochures for distribution to
employees traveling to malarious areas.
• Travel health clinics must have capabilities of displaying the malaria video to all
personnel traveling to malarious areas.
• Travel health clinics must provide travelers to malarious areas, with initial supply of
insect repellent and adequate chemoprophylaxis.
• Travel health clinics must record post-travel malaria cases and notify line
management.
3.1.2 ExxonMobil Travel Services
ExxonMobil Travel Service (EMTS) or designee shall notify travelers that have booked
flights to a known malaria area to remind them to consult their travel health services. .A
standard notification is available, "Dear Employee Message".
3.1.3 Employee
All personnel traveling even for a single night to the following broad geographic regions
of the world, are encouraged to check the Travax database on ExxonMobil intranet site
as early as possible before travel, to determine if their specific destination carries the risk
of exposure to malaria. This will provide adequate time to determine the malaria risk
and to obtain necessary travel health consultations and chemoprophylaxis medication
Areas of concern include, but are not limited to the following:

Africa
Central America
India and surrounding countries
Indonesia
Mexico
Middle East
South America
Southeast Asia

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Internal Malaria Control Program

Stewardship

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4.0 Malaria Control Program Stewardship

4.1 Objectives
The objective of ExxonMobil MCP are:

ÿ Zero cases in employee non-immune population
ÿ Zero “serious case” in employee semi-immune population
The definition of “serious case” is the following:

ÿ Fatality
ÿ Malaria case confirmed by approved laboratory test(s) resulting in lost work time
and one of the following criteria:
ÿ Parasitemia => 5%
ÿ Required IV treatment
ÿ Hospitalization
4.2 Notification/Reporting
Malaria cases in non-immune population and serious cases in semi-immune

population are notified to management within 24hours.
All cases in non-immune population and serious cases in semi-immune population

are investigated according to the malaria case investigation procedure
( Appendix 10)
All malaria cases are recorded in a health reporting database ( see HRS procedure)
and data from the database are analyzed and trends identified on a monthly basis at
a minimum.
All operations prepare a monthly report for management review. The number of
non-immune cases and serious cases in semi-immune population are normalized,
using 200,000 work hours as common denominator
4.3 Malaria Chemoprophylaxis Compliance Program (MCCP)
The MCCP objective is to enforce compliance of employees with the approved

chemoprophylaxis recommendations. In selected operations in high-risk areas,
compliance is verified through laboratory analysis of urine samples provided by
employees looking for the presence of the declared prophylaxis medicine. The
samples are collected on a periodic and random basis. All employees, rotators or
visitors traveling to the selected operations are required to sign an attestation with
their consent to be subjected to the testing.

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Procedures for testing, reporting results, medical review and medical evaluation and
maintenance of a central database have been developed according to forensic
process principles. (see Appendix 9)
Procedures for testing, reporting results, medical review and medical evaluation and
maintenance of a central database have been developed according to forensic
process

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[insert country /location name]
Malaria Control Program
Malaria Control Program Page 16 of 44

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1.0 Introduction
Malaria is one of the most serious world health problems of the 21st century. Approximately
300-500 million of the world's people are infected by the disease and between 1.5 to 2.7
million die from it every year.
Control of malaria infection is achieved through implementation of a management system

that focuses on the systematic use of tools for the preventing of malaria. This shall include
the ABCD program which provides for:
A. Awareness and Education measures

B. Bite avoidance and the use of personal protective measures and environmental
controls in living and work areas
C. The use of Chemoprophylaxis
D. Early Diagnosis and ready access to proper medical care.
Since the program relies on comprehension and compliance by all personnel, special
emphasis is given to risk awareness training and modification of risk behavior.
The key positions/functional units involved in MCP implementation include; the lead country
manager, the line management of the impacted business unit, the malaria control officer, the
in-country SHE and MOH resources
1.1 Purpose
The purpose of this procedure is to:
• Prevent malaria from occurring in non-immune personnel (expatriate employees,
dependents, visitors, rotators and contractors).
• Reduce the incidence of malaria amongst national (semi-immune) personnel.
• Minimize the seriousness of all malaria cases by ensuring access to early diagnosis and
treatment.
• Consistent and effective programs across ExxonMobil locations.
1.2 Scope
The Malaria Control Program (MCP) is applicable to all ExxonMobil personnel and their
dependents, who travel to or reside where malaria is known to be a significant health risk.
Non-immune employees and their dependents , e.g. expatriates, will be involved in all aspects
of the MCP . Semi-immune employees, who may have achieved some immunity due to long
term residence and repeated exposure to the malaria parasite, will benefit from the program
interventions that are not detrimental to their health.
Contractors are expected to protect their employees through the development and
implementation of a malaria control program, which should be consistent with ExxonMobil
Malaria Control Program recommendations. Contractors performing work on behalf of an
ExxonMobil Company are also expected to meet the requirements of this program.

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1.3 Identification of Risks
In consultation with ExxonMobil Medicine and Occupational Health (MOH), it has been
determined that the following malaria risks exist for this location:
• [insert types of malaria found and risk overview] See Travax Travelers Destination
• [insert locations and facilities affected] See Malaria Risk Matrix
1.4 Users
SHE contact, Operations management, MOH, MCO
[Insert other site-specific users]

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2.0 Procedures
2.1 Introduction
The following procedures describe how the elements of [insert location names]
malaria control program are to be executed
2.2 Detailed Procedures
The procedures for the following program elements are documented in Table 1
• Supply of insect repellents, laundry insecticide solutions and bed nets to personnel
• Administration of malaria arrival questionnaires and supply of pre-departure
handouts
• Providing chemoprophylaxis
• Early diagnosis and treatment
• Orientation and periodic training program for employees, dependents, visitors and
rotators
• Use of JOBS database
• Investigation and reporting of malaria cases
• Contractors compliance with requirements
• Verification and measurements
2.3 Environmental Vector Control
The Environmental Vector Control measures for each location are documented in
Table 2
3.0 Program Execution Resources
[Modify the following roles and responsibilities to correspond with your local
organization].
Lead Country Manager

The lead country manager is responsible for oversight and coordination of in-country MCP
implementation to insure consistency in program content and efficient use of in-country
resources.

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Business Line Management

• Actively support the Malaria Control Program
• Appoint a Malaria Control Officer (MCO)
• Review trends on malaria incidence on regular basis
In-country MOH
• Review and analyze new data on malaria risk, prevention and management.
• Identify and provide training and awareness materials.
• Conduct health risk assessment for each location.
• Identify and communicate program expectations (i.e., diagnosis, treatment and
notification) to preferred medical providers
• Assist MCO in addressing concerns raised by employees, preferred medical providers
and others.
• Review malaria incident data.
Malaria Control Officer (MCO) / SHE

• Develop and update as necessary the local malaria control program.
• Organize and supervise the implementation of the vector control program.
• Conduct inspections and audits of the vector control measures.
• Ensure that initial (orientation) and ongoing awareness training is provided.
• Distribute malaria awareness information.
• Organize the implementation of the behavior-based malaria safety program.
• Ensure elements of malaria program are included in contract specifications.
• Coordinate distribution of supplies for self protection/vector control.
• Ensure ready access to diagnostic and treatment services.
• Distribute pre-departure hand-outs.
• Collect and report program measurement and performance data .
Employee
• Adhere to program recommendations regarding chemoprophylaxis and personal
protection measures.
• Participate actively in the awareness program.
• Report any suspect fever immediately to the preferred medical provider when in-
country.
• Report any suspect fever immediately to the closest medical facility and your
supervisor upon return. Be sure to inform them you have been in a malaria-infected
area.
In-country preferred medical provider [insert names and contacts]

• Use rapid diagnosis method to test for malaria
• Report confirmed or unconfirmed cases of malaria to local ExxonMobil office.
• Provide malaria prophylaxis and treatment according to ExxonMobil protocols.
• Assist and provide advice to malaria control officer as needed.

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• Communicate with MOH or ExxonMobil Global Medical Assistant Company to clarify

issues related to malaria diagnosis and treatment as needed
• Ensure clinic staff understands ExxonMobil malaria requirements for
chemoprophylaxis, diagnostic and treatment.

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4.0 Verification and Measurements
The MCO must conduct and document periodic internal reviews of the malaria control program to
ensure that the procedures are being followed.
[Insert verification measures and periodicity of reviews]
The MCO will collect and report to line management the following data monthly
• Number of cases of malaria in non-immune population (visitors, rotators, employees and

dependents)
• Number of lost days for national employees due to malaria
• [ See Appendix 9 for additional considerations.]

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Table 1 - [Insert location name] Malaria Control Program Execution Plan

Program Activities Responsibility* Recipients * When/Where* How*
Elements (include all locations)
Training Supply Malaria questionnaire First time visitors, rotators
and expat and
dependents
Provide Arrival Health orientation
including malaria brochure and
video
Supply pre-departure handouts
Provide periodic health
awareness sessions
Display educational material
Vector control Oversee execution of
environmental control measures
plan
Personal Protection Supply of insect repellents
Supply of insecticide for laundry
Insecticide treatment of clothing
Supply of bed nets
Chemoprophylaxis Supply of chemoprophylaxis Non-immune personnel
Job Observation for Use JOBS database
Malaria Prevention
Diagnosis and Early consultation for malaria
treatment symptoms
Verify PMPs follow ExxonMobil
diagnostic and treatment
standards
Contractors Verify contractors program meet
compliance expectations
Incident Investigate malaria cases
investigation
Verification Collect verification measures
Measurements Collect measurement data
Report to management

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*Possible selections for completing your implementation chart:

Responsibility: MCO, MOH, SHE, Security, Procurement, Employees, PMPs
Recipients: Visitor, Expatriate, National, Rotators, Dependents
When/Where: Arrival/departure, frequency, location etc...
How: Site visit, Audit, Employee Interview, Use of HRS, Questionnaire

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Table 2 - Environmental Vector Control Plan

[Insert location name]
Environmental Vector Controls Personal

Protection
Facility Type Inspect Breeding Site Outdoor Indoor Outdoor Bed Nets
Controls Residual Residual Spraying/
Spraying Insecticides Fogging
Office Verify permanent Verify controls on Apply residual Have residual N/A N/A
insect proofing non-temporary insecticide on insecticide (or
has not breeding sites eaves and application
deteriorated have not exterior walls, contractor)
deteriorated below floor if available, use
Identify (and elevated as necessary
eliminate)
temporary
breeding sites
Private Residences Verify permanent Verify controls on Apply residual Have residual Use knock- Insecticide
including immediate insect proofing non-temporary insecticide on insecticide (or down spray treated bed net
surrounding has not breeding sites eaves, below application (fogging) prior available a
deteriorated have not floor if elevated contractor) to outdoor
deteriorated available, use evening event
Identify (and as necessary
eliminate)
temporary Issue aerosol
breeding sites insecticide as
secondary or
back-up
measure
Staff House Verify permanent Verify controls on Apply residual Have residual N/A Insecticide
including immediate insect proofing non-temporary insecticide on insecticide (or treated bed net
surrounding has not breeding sites exterior walls, application available a
deteriorated have not below floor if contractor)
deteriorated elevated. available, use
Identify (and as necessary
eliminate)
temporary Issue aerosol
breeding sites insecticide as
secondary or
back-up
measure
Hotel including Verify permanent Verify controls on Apply residual Have residual Use knock- Insecticide
immediate insect proofing non-temporary insecticide on insecticide (or down spray treated bed net
surrounding has not breeding sites exterior walls, application (fogging) prior available a
deteriorated have not below floor if contractor) to outdoor
deteriorated elevated available. evening event
Identify (and
eliminate) Issue aerosol
temporary insecticide as
breeding sites secondary or
back-up
measure

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Environmental Vector Controls Personal

Protection
Facility Type Inspect Breeding Site Outdoor Indoor Outdoor Bed Nets
Controls Residual Residual Spraying/
Spraying Insecticides Fogging
Outdoor Recreation Verify permanent N/A Use knock- N/A Use knock- N/A
Area insect proofing down spray down spray
has not (fogging) prior (fogging) prior
deteriorated to use if to use if
conditions conditions
Identify (and conducive to conducive to
eliminate) mosquito bite mosquito bite
temporary
breeding sites
Warehouse/ Storage Identify (and N/A Apply residual Apply residual N/A N/A
Area eliminate) insecticide on insecticide on
temporary exterior walls, interior walls,
breeding sites below floor if and ceilings
elevated
All Grounds not Identify (and Verify controls on Apply residual N/A N/A N/A
mentioned eliminate) non-temporary insecticide on
elsewhere temporary breeding sites exterior walls,
breeding sites have not fences, trees,
deteriorated shrubbery
Apply larvacide
as necessary.
Vehicles Note if vehicle N/A N/A Issue can of N/A N/A

has live insecticide to
mosquitoes each vehicle.
during each use
and, as
necessary, use
insecticide.
Field Camps Inspect to Weekly Apply residual Issue Consider Inspect to

determine inspections of insecticide on insecticide as based on determine
whether potential exterior walls, needed experience at whether
mosquito proofed breeding sites. below floor if site mosquito
elevated proofed.
Identify (and Monthly Require
eliminate) larvacide. Apply residual insecticide
temporary insecticide on treated bed nets
breeding sites trees, if not mosquito
shrubbery proof.
Note if temporary
structures or Insecticide
tents have live treated bed net
mosquitoes available
during each use
and, as
necessary, use
insecticide.
a. Structure should be mosquito proof
b. Use is around or after sunset, wind conditions are calm
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Appendices

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Appendix 1
Malaria Questionnaire
Name: Date of Entry:

Nationality: Date of Exit:
Company: Occupation:
Housing:
Chemoprophylaxis
What chemoprophylaxis are you now using?
What is your schedule for taking it?
Do you have a sufficient supply for your stay?
Mosquito Repellent
What mosquito repellent are you using?
Do you have a sufficient supply for your stay?
Permethrin Treatment
Are you aware of Permethrin treatment available for your clothing?
Do you have clothing that you want treated?
Do you know the procedure for having your clothing treated?
Please review the following questions. If you answer NO to any, please contact the Malaria
Control Officer as soon as possible.
• Are you aware and knowledgeable about the risk of malaria in this region?
• Do you know how to protect yourself from mosquito bites? (skin insect repellent, clothing
(treated, long sleeves/pants), bed nets).
• Are you able to comply with taking chemoprophylaxis appropriate for this region?
• Do you know the preferred medical provider to contact should you feel unwell to determine
if the diagnosis is malaria?
• Do you have an adequate supply of medications, insect repellents, insecticide for clothing,
bed nets, etc. for your stay?
• Do your housing facilities appear "mosquito-proof" (bed nets, screens etc.)?
I have read and understand the above, and I have no further questions for the Malaria
Control Officer at this point.
Signature Date
Please return this form to the Malaria Control Officer

(01-03)
Appendix 2
Worker Education
A-B-C-D Malaria Brochure
World Health Organization - Malaria

http://www.who.int/health-topics/malaria.htm
WHO Fact Sheet - Malaria

http://www.who.int/inf-fs/en/fact094.html
http://www.who.int/inf-fs/en/
Disease Information
http://www.who.int/health_topics/malaria/en/
Life Cycle of Plasmodium

http://www.who.int/tdr/diseases/malaria/lifecycle.htm
Travax
http://www.shoreland.com/prodserv/travax.html
Order direct from WHO

http://www.who.int/msa/mnh/ems/primacare/ppghc/orderfrm.htm
Video
• Just Another Day: video WHO Ref: 1650087
• Do we still need to die from Malaria: video WHO Ref: 1650065
• A Matter of Malaria: video WHO Ref: 1650061
• SPf66: video WHO Ref: 1650088
Books
Malaria: A Manual for Community Health Workers Ref: 1150445

(01-03)
Appendix 3
Post-Exposure Handouts
Information for the traveler leaving the malarious area

Awareness
It is important to remain aware of the risks of malaria during the departure
process and up to 4 weeks after arrival in Europe, the United States, Latin
America or elsewhere. Sitting around the hotel pool, having dinner at an
outside restaurant or waiting at the airport are opportunities to be exposed to
the malaria-carrying mosquitoes, especially from dusk to dawn. You should
not leave your awareness about malaria behind once the airplane takes off.
You can develop malaria after you have left the malarious country while on
your leave at home. Symptoms of malaria may not display themselves until 2-3
weeks after leaving the malarious area. Symptoms of malaria are not very
specific, particularly if you have correctly been taking prophylactic medication
(such as Malarone, mefloquine, Doxycycline or chloroquine/paludrine).
Malaria symptoms can include: fever, chills, muscle aching, eye pain,
headache, loss of appetite and vomiting or other "flu symptoms."
Bites
Mosquitoes may be present at the airport (even inside the airport buildings), so
keep applying insect repellents and wear appropriate clothing.
Compliance
Prophylactic antimalarials need to be taken up to 4 weeks after leaving the
malarious area using the same drug(s) you were taking while in country.
Diagnosis
If you develop any of the above symptoms within a 2-4 week period after
leaving a malarious are, you should seek medical advice (and a peripheral
blood malaria smear) IMMEDIATELY, even on a weekend. Untreated malaria
can be rapidly serious and even fatal in just a day or so.

(01-03)
Note for people previously exposed to malaria (vivax, ovale and malariae)
in other parts of the world: the Falciparum type of malaria found in West
Africa is much more serious than that found in other parts of the world, (e.g.,
Bolivia in South America). Thus, if you develop any of the above symptoms
within four weeks of leaving, it may be malaria of the more serious kind. Do
not delay evaluation and treatment because you think it is just another attack
of your previous mild malaria cases.)
Early diagnosis and treatment are paramount for combating this potentially life-
threatening disease. In addition, you need to inform your physician about
recent travel to a malarious area and indicate the prophylactic medication
taken. Many physicians, not working with returning travelers regularly, may
not readily recognize the symptoms of malaria. Also, keep in mind, your
symptoms may be atypical because of the prophylactic medication you are
taking. Appropriate forms for informing your physician can be obtained from
your malaria control officer.

(01-03)
To Employee: Please submit this form to your physician if you develop any
febrile illness as described in your handout "Information for the departing
traveler."
Dear Doctor:
This patient has been working/traveling in a malarious area, where he/she has been
exposed to malaria, specifically Plasmodium falciparum . This form of malaria is very
serious, even fatal, if not diagnosed and treated promptly. Prompt treatment with
proper therapy is essential, even if the diagnosis is not yet certain!
The prophylaxis that was recommended is either Malarone, mefloquine (commonly

known as Lariam), weekly chloroquine (500mg) with daily proguanil (200mg, also
known as Paludrine) or daily Doxycycline (100mg). Please note that prophylaxis is
around 90% effective for Malarone and Mefloquine and Doxycycline and around 50-
60% for chloroquine/ proguanil, even if taken as recommended. Thus, this patient may
still develop malaria.
All employees who experienced symptoms mimicking malaria have been counseled to
consult a doctor. PLEASE BE AWARE THAT MALARIA DEVELOPING WHILE ON
PROPHYLAXIS MAY PRESENT WITH VERY NON-SPECIFIC SYMPTOMS: low-
grade (or no) fever, malaise, headache, myalgic, gastric or flu-like complaints.
Malaria should be considered the diagnosis and we suggest arranging for evaluation
by means of a thick and thin blood smear examination for malaria parasites while other
diseases should be ruled out.
If parasites are detected, appropriate treatment should be started. Should you require
more advice on currently recommended treatment, please call the CDC's Malaria Hot
Line at 404-332-4555 or by fax 404-332-4565. In UK call the Malaria Reference
Laboratory at (+44) 0207 927 2427
Thank you for your attention to this patient.

(01-03)
Appendix 4
Malaria Chemoprophylaxis
Centers for Disease Control (CDC), 2001, Prescription Drugs for Preventing Malaria
http://www.cdc.gov/travel/malariadrugs.htm
CDC, 2001, Preventing Malaria in Infants and Children, February

http://www.cdc.gov/travel/mal_kids_pub.htm
CDC, 2001, Preventing Malaria in the Pregnant Woman

http://www.cdc.gov/travel/mal_preg_pub.htm
Antimalarial Drug Resistance, Guidelines for Surveillance and Containment, WHO

http://www.who.int/emc/amrpdfs/Drug_resistance_in_malaria.pdf
Special Issues:
General information regarding Human Immunodeficiency Virus and Travel

http://www.cdc.gov/travel/hivtrav.htm
WHO Expert Committee on Malaria

http://mosquito.who.int/docs/ecr20_toc.htm
Prevention of Malaria During Pregnancy

http://www.cdc.gov/ncidod/dpd/parasites/malaria/hcp_malaria_pregnant.htm
Prevention of Malaria in Infants and Children

http://www.cdc.gov/ncidod/dpd/parasites/malaria/hcp_malaria_children.htm
WHO References
http://mosquito.who.int/docs/ecr20_ref.htm
Management of severe malaria

http://mosquito.who.int/docs/hbsm_toc.htm
Management of uncomplicated malaria

http://mosquito.who.int/docs/ecr20_5.htm
Malaria prevention in the long term traveler

http://www.hc-sc.gc.ca/pphb-dgspsp/publicat/ccdr-rmtc/97vol23/23s5/25s5h_e.html
Treatment of malaria
http://www.hc-sc.gc.ca/pphb-dgspsp/publicat/ccdr-rmtc/97vol23/23s5/25s5h_e.html
Canadian Recommendations for the Prevention and Treatment of Malaria Among International
Travellers 1997
http://www.hc-sc.gc.ca/pphb-dgspsp/publicat/ccdr-rmtc/97vol23/23s5/index.html
Malaria Diagnosis
http://mosquito.who.int/docs/malaria_diagnosis.pdf

(01-03)
Appendix 5
Malaria Immunity (Premunition)
What is Malaria Immunity (Premunition)?

While it has been demonstrated that partial immunity against malaria does
exist, very little study and documentation of this subject has been done.
Inborn or acquired immunity following repeated attacks of malaria have mostly
been evidenced by observational studies. Children born to mothers in areas of
malaria holo-endemicity (or year round transmission ) acquire transplacental
immunity that provides at least partial protection in the first five months of life.
This must have been vital in the preservation of rural ethnic groups living in
the tropical rain forest zones of Africa and South America. Without this
maternally-transferred protection, the immunologically naïve babies would
have no defense against malaria and the tribes would probably have gone
extinct. This may also provide some explanation for the long period (15-25
years) taken for adults and even children born in non- malarious areas to
acquire partial immunity. Maybe, the intrauterine priming of the primitive
immune system, sets up the individual for a superior and accelerated malaria
immune competence in later life. It has also been observed in West Africa that
some people, for unexplained reasons, do not suffer from malaria. This group
is a target of malaria vaccine researchers who are digging to discover the
factor(s) responsible for their complete resistance to malaria.
A series of observation by Pierrre Druilhe and colleagues, working in the

margins of the Sahara Desert (Sahel region) of Africa brings to light a number
of issues. Druilhe did a longitudinal observational study of African ‘peasants’
and students who ‘immigrated’ to France from the Sahel. Most of them visited
their homeland in the fringes of the Sahara Desert after 3–4 years, while a few
visited home after two years. Some (medical students) visited home after nine
years of sojourn in France. They also observed the local population during
draught, when there was no rainfall and no mosquitoes, and after the draught,
when the rains came and there were abundant mosquitoes and malaria
transmission. They further made remarks on some mass antimalaria
programs involving ‘chloroquination’ of household salts and the aftermath,
when the programs were abandoned. A number of facts stands clear from this
study:
1. Anti-parasite malarial immunity (called Premunition ) certainly takes more

than 15 years to establish, generally 20-25 years to be fully effective, and
this is apparently independent of the rate of transmission by mosquitoes,
provided it is equal or above one infective bite per year. However, due to
placental transfer of passive immunity from previously semi-immune mothers
(01-03)
and other complex immune reactions that may follow very early exposure (as
is commonplace in the malarious tropics), premunition in children may take
less than 15 years to develop. Usually sometimes between the 5 th and 8 th
birthday, most West African children would settle into the same malaria attack
frequency as their parents.
2. This slowly acquired immunity is lost in 12 months if there is no ‘re-boosting.’

Re-boosting means at least one infective bite in one year. The shortest
period for the loss of this immunity is about 6 months without re-boosting.
3. Premunition, despite slowly being acquired, was recovered by a limited,
probably a single, re-boost of infective bite.
4. Of scientific interest is the observation that antibodies may play only a minor
role in malaria immune protection. This is demonstrated by the observation
that in adults (not in children) migrating to France, there was found no
decrease in IFA titers after up to 9 years spent outside the endemic area (the
confidence that there was no trip back was OK at least in the medical
students involved in this study). This is an additional argument, if needed,
against the absence of relevance of antibodies to whole Ag’s with protection.
5. Africans enrolled in the French Army (mainly from Burkina Faso) apparently
did not suffer much from malaria in Vietnam, and even if some did, they
could very well had been stationed in Europe for some time before being
sent in Vietnam (and therefore had time to lose their immunity as discussed
above).
Also during the construction of the Panama canal at the beginning of the
century, people of African descent suffered least from malaria, according to
records kept by the US Army at the time. At the time, the US Army described
it as "the natural resistance of the people of this race to malaria.” However
most of these were black migrant workers from malaria-infested Caribbean
and the Isthmus of Panama.

(01-03)
6. Several cellular and humoral mechanisms probably play a role in natural

immunity to Plasmodium falciparum malaria, but the development of an
effective vaccine has been impeded by uncertainty as to which antigens are
targeted by protective immune responses. Experimental models of malaria
have shown that cytotoxic T lymphocytes (CTL), which kill parasite-infected
hepatocytes, can provide complete protective immunity against certain
species of Plasmodium in mice, and studies in The Gambia have provided
indirect evidence that CTL play a protective role against P falciparum in
humans. However, in an endemic area, CTL levels in both children and
semi-immune adults with malaria were low, suggesting that boosting these
low levels by immunization might provide substantial or even complete
protection against infection and disease.
7. Although it might be expected that the size of the infecting inoculum would
influence the severity of the consequent malaria, evidence that it does so is
scarce.
Additional References:
1. Aidoo, M., A. Lalvani, C. E. M. Allsopp, et al. “Identification of conserved antigenic

components for a cytotoxic T lymphocyte-inducing vaccine against malaria.” Lancet
(22 Apr. 1995): 1003-1007
2. Glynn, J. R., and D. J. Bradley. “Inoculum size and severity of malaria induced with
Plasmodium ovale.” Acta Tropica (Mar. 1995): 65-70.
3. Druilhe Pierre, WEHI. (Monjour L., Richard-Lenoble D., Druilhe P., Gentilini M.
Influence de la sècheresse sur l’immunité anti-paludéenne. Nouv. Pr. Med., 1978,
7, 1651)

(01-03)
Appendix 6
Personal Protection
Skin Repellent
http://www.who.int/ctd/whopes/docs/barnard.pdf
Bednets
Safety of Pyrethroid Treated Mosquito Nets

http://www.who.int/ctd/whopes/sptmn_eng.pdf
Specifications for Netting Materials

http://whqlibdoc.who.int/hq/2001/WHO_CDS_RBM_2001.28.pdf
Guidelines on the Use of Insecticide-treated Mosquito Nets for the Prevention and Control of
Malaria in Africa
http://www.malaria.org/itmn1.html
Permethrin Treatment
Insecticide Treatment of Clothing (U.S. Navy reference)

http://nepmu6.med.navy.mil/Entomology/Permethrin%20SOP.pdf

(01-03)
Appendix 7
Vector Control Measures
Indoor Residual Insecticide
Manual for Indoor Residual Spraying-Application of Residual Sprays for Vector Control
http://www.who.int/ctd/whopes/docs/irs_manual.pdf
Vector Control Strategies

Malaria Vector Control in Africa: Strategies and Challenges
http://www.aaas.org/international/africa/malaria/toure.html
Vector Surveillance and Control

http://www.who.int/emc/diseases/ebola/Denguepublication/048-59.pdf
Relevant WHO Documents/Publications

http://www.who.int/ctd/whopes/relevant_docs.htm

(01-03)
Appendix 8
Malaria Diagnosis and Treatment
Bhave, S.Y., 1996. Malaria in Children. Bombay Hospital Journal, Vol. 38, No. 1,
January. Also cites WHO, 1990.
Bradley, D.J. and B. Bannister, 2001. Guidelines for malaria prevention in travelers from the United
Kingdom for 2001. Communicable Disease and Public Health. Vol. 4 No 2, pp. 84-101, June.
Defense Intelligence Agency, 2001. Medical Environmental Disease Intelligence and Countermeasures.
DI-1810-207-01. Washington, DC.
Health Canada, 2000. Canadian recommendations for the prevention and treatment of malaria among
international travelers. Canada Communicable Disease Report, Vol. 26S2, March.
http://www.hc-sc.gc.ca/pphb-dgspsp/publicat/ccdr-rmtc/97vol23/23s5/index.html
Navy Environmental Health Center, 2000. Navy Medical Department Pocket Guide to Malaria
Prevention and Control, September.
http://www.vnh.org/Malaria/Malaria.html
World Health Organization, 1990. Division of Control of Tropical Diseases. Severe and Complicated
Malaria, cited in Transactions of the Royal Society of Tropical Medicine and Hygiene, Vol. 84,
Supplement 2, pp. 1-65., 1988.
World Health Organization, 1996. Malaria, A manual for community health workers.
http://mosquito.who.int/docs/manual_chw.pdf
World Health Organization, 1997. Management of Uncomplicated Malaria and the Use of
Antimalarial Drugs for the Protection of Travelers. WHO/MAL/96.1075 Rev.1 (1997).
http://mosquito.who.int/docs/ecr20_5.htm#p5.1
World Health Organization, 1999. New Perspectives, Malaria Diagnosis. Report of a Joint
WHO/USAID Informal Consultation, October 25-27.
http://www.who.int/tdr/publications/publications/pdf/malaria_diagnosis.pdf
World Health Organization, 2000. Management of severe malaria. A practical handbook, second
edition.
http://mosquito.who.int/docs/hbsm_toc.htm
WHO Expert Committee on Malaria, Twentieth report.
http://mosquito.who.int/docs/ecr20_5.htm
WHO/TDR Malaria Database

http://www.wehi.edu.au/MalDB-www/who.html
Artemisinin Derivatives (Qinghaosu) for the Treatment of Drug-Resistant Malaria
http://www.hc-sc.gc.ca/pphb-dgspsp/publicat/ccdr-rmtc/00vol26/26s2/26s2j_e.html
Self Treatment of Presumptive Malaria

2000 Canadian recommendations for the prevention and treatment of malaria among
international travellers
http://www.hc-sc.gc.ca/pphb-dgspsp/publicat/ccdr-rmtc/00vol26/26s2/26s2g_e.html

(01-03)
Appendix 9
Verification and Measurement Inspections and Audits
Malaria Chemoprophylaxis Compliance Program (MCCP):
Purpose is to verify the use of effective malaria chemoprophylaxis by non-immune

Project personnel (typically expatriates) while in malaria prone areas
ß MCCP includes unannounced, random, and periodic testing of urine specimens to

verify the presence of one of the effective anti-malarial medications
ß Individuals without laboratory evidence of an effective anti-malaria medication

undergo a medical evaluation and restart medication under medical supervision in
order to assess fitness to work in a malaria risk area
+Also entered into a “Frequent Testing Pool” for several months
ß Lack of detectable effective anti-malaria medication in urine does not necessarily

mean MCP non-compliance AND presence of anti-malaria medication in urine does
not necessarily mean there is adequate malaria protection
ß MCCP applies to all non-immune personnel (typically expatriates) working in

malaria risk areas (both ExxonMobil and contractor/sub-contractor employees)–
Includes residents, rotators, and business travelers
ß All non-immune ExxonMobil and contractor/sub-contractor personnel working in

malaria risk areas are required to sign a form indicating their understanding of and
compliance with the anti-malarial medication requirements of the MCP
ß Any individual who is unwilling or unable to agree to the malaria chemoprophylaxis

use requirements of the MCP and so indicates by not signing a MCCP Attestation
Form will be considered unfit for work in malaria risk areas
ß Non-immune dependents resident in Chad/Cameroon are strongly encouraged to

take effective malaria chemoprophylaxis but will not be tested under the MCCP
ß Malaria chemoprophylaxis is not medically recommended for semi-immune
personnel (typically Nationals) Nationals are not included in the MCCP

(01-03)
Appendix 10
Malaria Case Investigation Form
General Information:
Last Name: First Name: Job Location
Early Diagnosis and Treatment:
Onset of symptoms: Date Time Location
Fever Chills Headache Diarrhea Others
Consultation: Date Time Location
Name of health professional
Diagnosis: Date Time Location
Confirmation: Microscopic slide ICT QBC Other None
Treatment Date Time Which medicine
Awareness:
Person received information / training on malaria transmission, prevention, and

treatment?
Initial Training Refresher Training
If not, note reason(s).
Bite Prevention:
Suspected time and location where bite occurred.

(01-03)
Appendix 10
Malaria Case Investigation Form
Page 2
Bite Prevention: (Contender)
Person uses applicable bite prevention measures?

Use of repellent
Use of Permethrin on clothes
Wears long sleeves / pants
Use of bed net
What vector control measures are applicable at this location?
Are these vector control measures implemented in accordance with the MCP?.
Chemoprophylaxis:
Person takes prophylaxis according to regimen recommended by MOH?

Date person commenced taking prophylaxis
Type of prophylaxis
Frequency
Other Comments

(01-03)
Countries at Risk for Malaria
Afghanistan | Algeria | Angola | Argentina | Armenia | Azerbaijan | Bangladesh | Belize | Benin | Bhutan | Bolivia | Botswana | Brazil
Burkina Faso | Burundi | Cambodia | Cameroon | Central African Republic | Chad | China | Colombia | Comoros | Congo
Congo, Democratic Republic of (formerly Zaire) | Costa Rica | Djibouti | Dominican Republic | Ecuador | El Salvador | Equatorial Guinea
Eritrea | Ethiopia | French Guiana | Gabon | Gambia |Georgia | Ghana | Guatemala | Guinea | Guinea-Bissau | Guyana | Haiti | Honduras
India | Indonesia | Iran | Iraq | Ivory Coast | Kenya | Korea | Laos | Liberia | Madagascar | Malawi | Malaysia | Mali | Mauritania | Mauritius
Mayotte | Mexico | Western Sahara (Morocco) | Mozambique | Myanmar (Burma) | Namibia | Nepal | Nicaragua | Niger | Nigeria |Oman
Pakistan | Panama | Papua New Guinea | Paraguay | Peru | Philippines | Rwanda | Sao Tome & Principe | Saudi Arabia | Senegal | Sierra
Leone | Solomon Is. | Somalia | South Africa | Sri Lanka | Sudan | Suriname | Swaziland | Syrian Arab Republic | Tajikistan | Tanzania
Thailand | Togo | Turkey | Turkmenistan |Uganda | United Arab Emerates | Uzbekistan Vanuatu | Venezuela | Viet Nam | Western Sahara
(Morocco) | Yemen | Zambia | Zimbabwe
PROPHYLAXIS
PREFERRED ANIT-MALARIAL LOCATION OF
COUNTRY TYPE EM LOCATIONS REQUIRED FOR
AGENT FOR HIGH RISK AREA RISK
EM LOCATIONS
AFGHANISTAN N/A Throughout the country below

P. vivax Yes Mefloquine/Malarone/Doxycyline
MAP 5,500 ft. (2,000 meters)
ALBANIA N/A N/A No N/A N/A
ALGERIA N/A
P. vivax No Chloroquine Remote southern areas
MAP
AMERICAN N/A
N/A N/A N/A N/A
SAMOA
ANDORRA N/A N/A No N/A N/A
ANGOLA P. falciparum
N/A Yes Mefloquine/Malarone/Doxycyline Risk exists in the whole country
MAP throughout the entire year
Yes
Yes
ANDORRA N/A N/A N/A N/A N/A
ANGUILLA N/A N/A N/A N/A N/A
ANTIGUA & N/A

N/A N/A N/A N/A
BARBUDA
ARGENTINA N/A No Along the Bolivia and Paraguay

P. vivax Chloroquine
MAP borders
No
Risk exists in focal areas on the

western border with Turkey
ARMENIA P. vivax N/A Yes Chloroquine (June-October). Risk exists
MAP
mainly in the Ararat Valley with
most cases in the Masis district.
ARUBA N/A N/A N/A N/A N/A
ASCENSION N/A N/A N/A N/A N/A
AUSTRALIA N/A N/A N/A N/A N/A

AUSTRIA N/A N/A N/A N/A N/A
AZERBAIJAN P. vivax N/A No Chloroquine Risk exists in the lowland areas

MAP in the far south, mostly between
the Kura and Araks Rivers (June-
October).
AZORES N/A N/A N/A N/A N/A
BAHAMAS N/A N/A N/A N/A N/A
BAHRAIN N/A N/A N/A N/A N/A
BANGLADESH 50% P. falciparum N/A Yes Mefloquine/Malarone/Doxycyline Exists in the whole country
MAP throughout the year excluding
Dhaka City
BARBADOS N/A N/A N/A N/A N/A
BELARUS N/A N/A N/A N/A N/A
BELGIUM N/A N/A N/A N/A N/A
N/A
BELIZE 95% P. vivax N/A N/A Chloroquine Risk exists in the whole country
MAP 5% P. falciparum throughout the year including
forest preserves, resorts and
shore islands. The only
area is central coastal Belize
BENIN P. falciparum N/A Mefloquine/Malarone/Doxycyline Risk exists in the whole country

MAP throughout the year
BERMUDA N/A N/A N/A N/A
Mefloquine/Malarone/Doxycyline Risk exists throughout the year in

BHUTAN N/A
P. falciparum
MAP southern districts bordering India.
BOLIVIA P. vivax P. N/A Yes Mefloquine/Malarone/Doxycyline Risk exists throughout the year.
MAP falciparum It is highest below 8,200 feet.
Malaria is more likely to occur in
Beni and Pando (northeastern
areas bordering Brazil. There is
no risk on many typical itineraries
including all urban areas and
high altitude destinations
BOSNIA AND N/A

N/A N/A N/A N/A
HERZEGOVINA
BOTSWANA P. falciparum N/A Yes Mefloquine/Malarone/Doxycyline Risk exists from November to

MAP June in the northern parts of the
country which comprise the
majority of popular tourist
destinations
BRAZIL P. falciparum N/A No Mefloquine/Malarone/Doxycyline High risk exists throughout the

MAP year in the Legal Amazonia
region. Risk for ExxonMobil
locations exists in Belem only.
No risk exists in the coastal
states from the horn to the
Uruguay border, Iguassu Falls,
and other major tourist and
business destinations
BRITISH VIRGIN
N/A N/A N/A N/A
ISLANDS
BRUNEI
N/A N/A N/A N/A
DARUSSALAM
BULGARIA N/A N/A N/A N/A
BURKINA FASO N/A Yes Mefloquine/Malarone/Doxycyline Risk exists in the whole country
P. falciparum
MAP throughout the entire year.
BURUNDI P. falciparum Yes Mefloquine/Malarone/Doxycyline Risk exists in the whole country

Risk exists in the whole country

CAMBODIA
P. falciparum Yes Mefloquine/Malarone/Doxycyline except Phnom Penh or
MAP
immediately around Tonle Sap
CAMEROON P. falciparum Yes Mefloquine/Malarone/Doxycyline Risk exists in the whole country

N/A
CANADA N/A N/A N/A
CAYMAN N/A N/A N/A N/A

N/A
ISLANDS
CENTRAL
AFRICAN Risk exists in the whole country
P. falciparum Yes Mefloquine/Malarone/Doxycyline
REPUBLIC throughout the entire year.
MAP
CHAD P. falciparum N/A Yes Mefloquine/Malarone/Doxycyline

MAP Risk exists in the whole country
throughout the entire year.
CHANNEL
N/A N/A N/A N/A
ISLAND
CHILE N/A N/A N/A N/A N/A

CHINA P. vivax
N/A No Chloroquine Travelers visiting cities and
MAP P. falciparum popular rural sites on all usual
tourist routes and cruises are not
at risk and antimalarial drugs are
not recommended for such
travelers.
CHRISTMAS N/A N/A N/A N/A

ISLAND
COLOMBIA 46% P. vivax N/A No/ Mefloquine/Malarone/Doxycyline Risk is high throughout the year
MAP 54% P. falciparum Yes in almost all rural or jungle areas
below 2,600 ft. (800 meters).
No Highest risk in Amazonas,
Choco, Cordoba, Guainia,
Guaviare, Putumayo and
Vichada
COMOROS P. falciparum N/A Yes Mefloquine/Malarone/Doxycyline Risk exists in the whole country
MAP throughout the year
CONGO P. falciparum N/A Yes Mefloquine/Malarone/Doxycyline Risk exists in the whole country
MAP including major cities.
CONGO P. falciparum N/A Yes Mefloquine/Malarone/Doxycyline

DEMOCRATIC
REPUBLIC OF Risk exists in the whole country
(FORMERLY throughout the entire year.
ZAIRE)
MAP
COOK ISLAND N/A N/A N/A N/A N/A
COSTA RICA P. vivax N/A No/ Chloroquine Risk exists in the rural lowland
MAP Yes areas below 1,600 ft. (500
meters). In Alajuela,
Guanacaste, Heredia and
provinces.
COTE D'IVOIRE P. falciparum Yes Mefloquine/Malarone/Doxycyline Risk exists in the whole country
CROATIA N/A N/A N/A N/A
CUBA N/A N/A N/A N/A
CYPRUS N/A N/A N/A N/A
CZECH
N/A N/A N/A N/A
REPUBLIC
DENMARK N/A N/A N/A N/A
DJIBOUTI P. falciparum N/A Yes Mefloquine/Malarone/Doxycyline Risk exists in the whole country
DOMINICA N/A N/A N/A N/A
DOMINICAN P. falciparum N/A No Chloroquine Risk exists throughout the year in

REPUBLIC all rural areas (including all
MAP coastal tourist resorts). Highest
risk occurs in the western
provinces bordering Haiti
Yes Mefloquine/Malarone/Doxycyline Risk exists in the whole country

EAST TIMOR N/A
P. falciparum
ECUADOR 50% P. vivax N/A No Mefloquine/Malarone/Doxycyline Risk exists at altitudes less than
MAP 50% P. falciparum 5,000 ft. (1,500 meters)
throughout the year.
EGYPT N/A N/A N/A N/A
N/A No Risk exists throughout the

EL SLAVADOR country in rural areas of the
P. vivax Chloroquine
MAP departments of Santa Ana,
Ahuachapan and La Union
EQUATORIAL P. falciparum Yes Mefloquine/Malarone/Doxycyline Risk exists in the whole country

GUINEA MAP throughout the entire year.
No/ Risk exists in the whole country

ERITREA Yes below 7,200 ft. (2,200 meters)
P. falciparum Mefloquine/Malarone/Doxycyline
is no risk in Asmara.
ESTONIA N/A N/A N/A N/A
ETHIOPIA P. falciparum Risk exists lower than 6,500 ft.

MAP (2,000 meters) throughout the
No Mefloquine/Malarone/Doxycyline entire year. No risk exists in
Addis Ababa and other
location higher than 6,500 ft.
FALKLAND
N/A N/A N/A N/A
ISLANDS
FAROE ISLANDS N/A N/A N/A N/A
FIJI N/A N/A N/A N/A
FINLAND N/A N/A N/A N/A
FRANCE N/A N/A N/A N/A
Risk exists throughout the

FRENCH country including Cayenne and
GUIANA P. falciparum Yes Mefloquine/Malarone/Doxycyline vicinity. It is highest in 9
MAP municipalities of the territory
bordering Brazil and Surinam.
FRENCH N/A N/A N/A N/A

POLYNESIA
GABON P. falciparum N/A Yes Mefloquine/Malarone/Doxycyline

MAP
GALAPAGOS N/A N/A N/A N/A

GAMBIA throughout the entire year.
MAP Highest risk is from June-
December
Risk exists focally from July-

GEORGIA
P. vivax Yes Cholroquine October in some southeastern
MAP
villages.
GERMANY N/A N/A N/A N/A
N/A
N/A
N/A
GHANA P. falciparum N/A Yes Mefloquine/Malarone/Doxycyline

MAP
GIBRALTAR N/A N/A N/A N/A
GREECE N/A N/A N/A N/A
GREENLAND N/A N/A N/A N/A
GRENADA N/A N/A N/A N/A
GUADELOUPE N/A N/A N/A N/A
GUAM N/A N/A N/A N/A
GUATEMALA P. vivax Yes Risk exists in rural lowlands

MAP Chloroquine below 5,000 ft. (1,500 meters).
Risk is high in the jungle areas of
Alta Verapaz, Baja Verapaz,
No Peten and San Marcos. There is
no risk in tourist areas of the
central highlands.
GUINEA P. falciparum N/A Yes Mefloquine/Malarone/Doxycyline Risk exists in the whole country
GUINEA-BISSAU P. falciparum Yes Mefloquine/Malarone/Doxycyline Risk exists in the whole country

GUYANA P. falciparum N/A Yes/ Mefloquine/Malarone/Doxycyline Risk exists in the whole country
MAP No outside of Georgetown. High risk
in all interior regions. Sporadic
cases exist along the costal
regions.
HAITI Risk exists in the whole country

P. falciparum Yes Chloroquine throughout the entire year. The
MAP
greatest risk is in the coastal
areas especially in the south.
HONDURAS P. vivax N/A Yes Chloroquine Risk exists throughout the year in
MAP rural areas including diving
resorts on the Caribbean coast
and Bay Islands and within the
municipalities of Tegucigalpa and
San Pedro Sula.
HONG KONG N/A N/A N/A N/A
HUNGARY N/A N/A N/A N/A
ICELAND N/A N/A N/A N/A
INDIA P. falciparum N/A Yes Mefloquine/Malarone/Doxycyline Risk exists throughout the year
MAP including all major urban areas.
Exceptions are portions of
Himachal Pradesh, Sikkim,
Jammu and Kashmir above
6,000 ft.
INDONESIA P. falciparum No/ Mefloquine/Malarone/Doxycyline Risk (predominantly P.

Yes falciparum) exists throughout the
MAP year in all areas of Papua
(western half of the island of New
Guinea) and in rural areas of all
Chloroquine other islands (areas not usually
visited by tourists). The
metropolitan areas of Jakarta,
Jogyakarta, Surabaya, Bandung,
Solo, and Medan are risk free.
On Bali, the metropolitan areas
of Denpasar and all usual rural
tourist areas are risk free as are
usual tourist resorts on Java.
IRAN, ISLAMIC P. falciparum Yes Mefloquine/Malarone/Doxycycline Risk (approximately 50%

REPUBLIC OF falciparum) exists throughout the
MAP year in the provinces of Sistan va
Baluchestan, Hormozgan, and
Bushehr; the southern parts of
the provinces of Fars, Ilam,
Kerman, Kohkiluyeh va Buyer
Ahmadi, Lorestan, and Chahar
Mahall va Bakhtiari; and the
north of Khuzestan. Highest risk
is from March through November
in the south and during summer
months in the west.
The highest risk is from May-
IRAQ November in areas below 5,000
P. vivax Yes Mefloquine/Malarone/Doxycyline
MAP ft (1,500 meters). Baghdad is
risk free.
IRELAND N/A N/A N/A N/A
ISRAEL N/A N/A N/A N/A
ITALY N/A N/A N/A N/A
JAMAICA N/A N/A N/A N/A
N/A
JAPAN N/A N/A N/A N/A

N/A
JORDAN N/A N/A N/A N/A
KAZAKHSTAN N/A N/A N/A N/A
KENYA P. falciparum N/A Yes/ Mefloquine/Malarone/Doxycyline Risk exists in the whole country
MAP No throughout the year and in all
coastal beach resorts. Generally
no risk in Nairobi.
KIRIBATI N/A N/A N/A N/A
KOREA,
DEMOCRATIC
N/A N/A N/A N/A
PEOPLE'S
REPUBLIC OF
Limited risk for overnight stays

KOREA,
during the spring and summer in
REPUBLIC OF P. vivax No Chloroquine
the far northern areas bordering
MAP
North Korea.
KUWAIT N/A N/A N/A N/A
KYRGYZSTAN N/A N/A N/A N/A
LAOS, PEOPLE'S P. falciparum Yes Mefloquine/Malarone/Doxycyline Risk exists in the whole country.
DEMOCRATIC There is no risk in the city of
REPUBLIC Vientiane.
MAP
LATVIA N/A N/A N/A N/A
LEBANON N/A N/A N/A N/A
LESOTHO N/A N/A N/A N/A

LIBERIA
P. falciparum Yes Mefloquine/Malarone/Doxycyline throughout the entire year
MAP
including major cities.
LIBYA N/A N/A N/A N/A
LIECHTENSTEIN N/A N/A N/A N/A
LITHUANIA N/A N/A N/A N/A
LUXEMBOURG N/A N/A N/A N/A
MACAO N/A N/A N/A N/A
MACEDONIA N/A N/A N/A N/A
MADAGASCAR Risk exist in all areas with the

MAP highest risk in the coastal areas.
MADEIRA
N/A N/A N/A N/A
ISLAND
MALAWI P. falciparum N/A Yes Mefloquine/Malarone/Doxycyline Risk exists in the whole country
MALAYSIA P. falciparum N/A No Mefloquine/Doxycyline/ Risk exists in remote areas of the

*
MAP Malarone peninsula. Urban and coastal
areas are risk free.
*
Malarone is not yet available in
Malaysia
MALDIVES N/A N/A N/A N/A
MALI P. falciparum N/A Yes Mefloquine/Malarone/Doxycyline Risk exist in the whole country
MALTA N/A N/A N/A N/A
MARSHALL
N/A N/A N/A N/A
ISLANDS
MARTINIQUE N/A N/A N/A N/A

No/ Mefloquine/Malarone/Doxycyline
MAURITANIA P. falciparum N/A Risk exist in the whole country.
MAP Yes Risk does not exist in the
provinces of Dakhlet
Nouadhibou and Tiris
Zemmour.
Risk exists in rural areas of

Pamplemousses, Plaines
MAURITIUS Wilhelms, Riviere de Rampart,
P. vivax Yes Chloroquine
MAP and Grand Port. No risk in Port
Louis or in coastal resorts and
their immediate surroundings.
MAYOTTE
P. falciparum Yes Mefloquine/Malarone/Doxycyline Risk exists in the whole country.
MAP
MEXICO P. vivax N/A No Chloroquine

MAP Risk exists throughout the year
including resorts in rural areas.
MICRONESIA,
FEDERATED N/A N/A N/A N/A
STATES OF
MOLDOVA,
N/A N/A N/A N/A
REPUBLIC OF
MONACO N/A N/A N/A N/A
MONGOLIA N/A N/A N/A N/A
MONTSERRAT N/A N/A N/A N/A
MOROCCO P. vivax No Chloroquine Very limited risk (exclusively

(WESTERN P. falciparum Mefloquine/Malarone/Doxycycline vivax) may exist in limited foci
SARAH) from May to October in
MAP Khouribga Province in rural
areas located off typical tourist
itineraries. In the territory of
Western Sahara, risk (exclusively
P. falciparum) exists along the
border with Mauritania. The
cities of Tangier, Rabat,
Casablanca, Marrakech, and
Fez do not have risk.
MOZAMBIQUE P. falciparum N/A Yes Mefloquine/Malarone/Doxycycline

MAP Risk exists in the whole country
Risk exists in rural areas below

MYANMAR
3,000 ft. (1,000 meters).
(FORMERLY P. falciparum Yes Mefloquine/Malarone/Doxycyline
exists in the cities of Yangon
BURMA) MAP
and Mandalay.
Risk exists along the Kavango

and Kunene rivers and from
NAMIBIA
P. falciparum Yes Mefloquine/Malarone/Doxycyline November-June in the northern
MAP
regions of Omaheke and
Otjozondjupa.
NAURU N/A N/A N/A N/A
NEPAL P. vivax Yes Mefloquine/Malarone/Doxycyline Risk exists in rural areas below

MAP 6,500 ft.
NETHERLANDS N/A N/A N/A N/A
NETHERLANDS
N/A N/A N/A N/A
ANTILLES
NEVIS N/A N/A N/A N/A
NEW
N/A N/A N/A N/A
CALEDONIA
NEW ZEALAND N/A N/A N/A N/A
NICARAGUA 95% P. vivax N/A Yes Chloroquine Risk exists in all rural areas. It
MAP 5% P. falciparum also exists in the outskirts of
Managua and all along the
shores of Lake Managua.
NIGER P. falciparum Yes Mefloquine/Malarone/Doxycyline Risk exists in the whole country
NIGERIA P. falciparum N/A Yes Mefloquine/Malarone/Doxycyline Risk exists in the whole country
MAP and includes urban areas.
NIUE N/A N/A N/A N/A
NORTHERN
MARIANA N/A N/A N/A N/A
ISLANDS
NORWAY N/A N/A N/A N/A
No
(Se
OMAN Very limited risk in remote areas
P. falciparum e Mefloquine/Malarone/Doxycyline
MAP of Musandam province.
Not
es)
PAKISTAN 50% P. falciparum N/A Yes Mefloquine/Malarone/Doxycyline Risk exists in all areas below
MAP 6,500 ft. (2,000 meters),
including all cities. The highest
risk is in July and August.
PALAU N/A N/A N/A N/A
PANAMA P. vivax P. No Chloroquine (west of the canal Risk exists in rural areas and in
MAP falciparum zone) the east and northwest
Mefloquine/Malarone/Doxycycline provinces. No risk in Panama
(east of the canal zone) City and vicinity nor in the
central highlands above 3,300
ft. and in the Canal Zone.
PAPUA NEW P. falciparum N/A Yes Mefloquine/Malarone/Doxycyline
GUINEA MAP Risk exists in the whole country
and includes urban areas.
Risk exists in some rural areas.

PARAGUAY
MAP
P. vivax No Chloroquine There is no risk for travelers to
Iguassu Falls.
PERU 66% P. vivax No Chloroquine Risk exists all year in nearly all
MAP 34% P. falciparum Exception: Use rural areas below 4,900 ft.
Mefloquine/Malarone/Doxycycline Significant risk exists in the
in provinces bordering Brazil and Amazon region and its
Ecuador tributaries. No risk exists in
Lima City and vacinity, coastal
areas south of Lima or in the
southern highland tourist
areas.
PHILIPPINES P. falciparum N/A No Mefloquine/Malarone/Doxycyline Risk exists in all rurual regions

MAP and islands, except for the
provinces of Bohol,
Catanduanes and Cebu and
metropolitan Manila.
PITCAIRN N/A N/A N/A N/A
POLAND N/A N/A N/A N/A
N/A
PORTUGAL N/A N/A N/A N/A
PUERTO RICO N/A N/A N/A N/A
QATAR N/A N/A N/A N/A
REUNION N/A N/A N/A N/A N/A
N/A
ROMANIA N/A N/A N/A N/A
RUSSIAN N/A N/A N/A N/A

FEDERATION
RWANDA Risk exists in the whole country
MAP throughout the year.
ST. HELENA N/A N/A N/A N/A
ST. KITS AND

N/A N/A N/A N/A
NEVIS
ST. LUCIA N/A N/A N/A N/A
ST. PIERRE AND N/A N/A N/A N/A

MIQUELON
ST. VINCENT
AND N/A N/A N/A N/A
GRENADINES
SAMOA N/A N/A N/A N/A
SAN MARINO N/A N/A N/A N/A
SAO TOME AND

PRINCIPE P. falciparum Yes Mefloquine/Malarone/Doxycyline
MAP
SAUDI ARABIA P. falciparum N/A No Mefloquine/Malarone/Doxycyline Risk exists in the southern and
MAP south western provinces and
towns. No risk exists in Mecca,
Medina, Jeddah, Jubail or Taif.
SENEGAL P. falciparum Yes Mefloquine/Malarone/Doxycyline Risk exists in the whole country

SEYCHELLES N/A N/A N/A N/A
SIERRA LEONE Risk exists in the whole country

SINGAPORE N/A N/A N/A N/A N/A
SLOVAKIA N/A N/A N/A N/A
SLOVENIA N/A N/A N/A N/A

SOLOMON P. falciparum N/A Yes Mefloquine/Malarone/Doxycyline
Extremely high risk exists in the
ISLANDS country.
MAP
SOMALIA Risk exists in the whole country

SOUTH AFRICA P. falciparum N/A No Mefloquine/Malarone/Doxycyline Risk exists in rural low altitude
MAP areas of northern provinces. Also
in coastal lowlands. The highest
risk is from October-May.
is no risk in major cities or
resorts.
SPAIN N/A N/A N/A N/A
SRI LANKA P. falciparum Yes Mefloquine/Malarone/Doxycyline Risk exists in the whole country
MAP throughout the year. There is no
risk in the districts of
Colombo, Kalutara and
Nuwara Eliya.
SUDAN P. falciparum N/A Yes Mefloquine/Malarone/Doxycyline Risk exists in the whole country
Risk exists in rural areas.

SURINAME does not exist in Parmaribo
P. falciparum No Mefloquine/Malarone/Doxycyline
MAP district and in the coastal area
0 North.
north of 5

throughout the year. There is no
SWAZILAND
P. falciparum Yes Mefloquine/Malarone/Doxycyline risk in the districts of
MAP
Colombo, Kalutara and
Nuwara Eliya.
SWEDEN N/A N/A N/A N/A
SWITZERLAND N/A N/A N/A N/A
SYRIAN ARAB P. vivax No Chloroquine Risk exists May-October in foci

REPUBLIC along the northern border and in
MAP the northeast part of the country.
TAIWAN N/A N/A N/A N/A
N/A
TAJIKISTAN P. vivax No Chloroquine Risk (predominantly P. vivax

MAP exists between the months of
June and October, particularly in
southern border areas (Khatlon
region), and in some central
(Dushanbe), western (Gorno-
Badakhshan), and northern
(Leninabad) areas.
TANZANIA P. falciparum Yes Mefloquine/Malarone/Doxycyline Risk exists in altitudes lower than

MAP 5,900 ft.
THAILAND P. falciparum N/A No Mefloquine/Malarone/Doxycyline Risk limited to evening and

MAP nighttime exposure in rural
forest/jungle areas. There is no
risk in the interior nor in the
cities and main tourist resorts.
TOGO Risk exists in the whole country

MAP and in major cities.
TONGA N/A N/A N/A N/A
TRINIDAD AND
N/A N/A N/A N/A
TOBAGO
TUNISIA N/A N/A N/A N/A N/A

N/A
N/A
N/A
TURKEY P. vivax No Chloroquine Limited risk exists in the

MAP southeastern part of the country
from the coastal city of Mersin to
the Iraqi border
(Cukurova/Amikova area). There
is no risk in any usual tourist
area (including Istanbul and
entire west and southwest of
Turkey) or at the Incirlik U.S. Air
Force base, or on any usual
cruise itinerary.
TURKMENISTAN P. vivax No Chloroquine Very low risk (exclusively

MAP vivax) exists in the east and
southeast, mostly in the Kushka
district. Highest risk is from June
to September.
TURKS AND
N/A N/A N/A N/A
CAICOS
TUVALU N/A N/A N/A N/A
UGANDA Risk exists in the whole country

UKRAINE N/A N/A N/A N/A

UNITED ARAB P. falciparum N/A No Mefloquine/Malarone/Doxycyline Limited risk in the foothill areas
EMIRATES and valleys of the northern
MAP emirates bordering Oman's
Musandam province. There is
no risk in Abu Dhabi, Dubai,
Ajman, Umm al Qaiwan or
Sharja.
UNITED N/A N/A N/A N/A

KINGDOM N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
UNITED STATES N/A N/A N/A N/A
URUGUAY N/A N/A N/A N/A
Very low risk exists in Qarshi and

UZBEKISTAN
P. vivax Yes Chloroquine Termiz districts. Highest risk from
MAP
June-September
VANUATU Risk exists in the whole country

VENEZUELA P. vivax N/A No Mefloquine/Malarone/Doxycyline Risk exists in rural areas.

MAP P. falciparum is no risk in Caracas,
Maracaibo, Merida, Margarita
Island or coastal resorts.
VIET NAM P. falciparum N/A No Mefloquine/Malarone/Doxycyline Risk exists in all rural areas.
MAP risk in the Red river delta
region and coastal plain north
of Nha Trang. The highest risk
in the two southern provinces Ca
Mau and Bac Lieu and the
forested highland areas below
4,900 ft.
VIRGIN ISLANDS N/A N/A N/A N/A
WAKE ISLAND N/A N/A N/A N/A

Risk exists below 6,500 ft.
YEMEN
P. falciparum Yes Mefloquine/Malarone/Doxycyline is no risk in Sana'a or at
MAP
elevations above 6,500 ft.
YUGOSLAVIA,
FEDERAL N/A No N/A N/A
REPUBLIC OF
ZAMBIA, THE
Risk exists in the whole country.
REPUBLIC OF P. falciparum Yes Mefloquine/Malarone/Doxycyline
Risk is lower in Lusaka.
MAP

except in the cities of
ZIMBABWE
P. falciparum No Mefloquine/Malarone/Doxycyline Bulawayo and Harare and in
MAP
the eastern highlands.
highest from November-June.
2.0 SCOPE OF SERVICES
This scope of work describes the medical and administrative services to be provided by the preferred medical
provider (Contractor) to eligible personnel of the Company under this agreement.
1. Coverage
Contractor will provide the medical services described below to Company-eligible personnel and dependents.
All services will be compensated at the Contractor's reasonable and customary rates for similar services unless
previously agreed to by Company and Contractor. Contractor will provide Company with updated fee schedule,
where appropriate. Company will not guarantee payment for any services rendered to non-eligible personnel.
The Company will establish procedures to assist the Contractor identify eligible personnel and dependents.
2. Medical Services Orientation

At Company request, Contractor shall conduct individual or family interviews and provide a facility visit,
including a full description of the services available and how they can be accessed, routinely and for
emergencies. The Contractor may charge a rate comparable to a regular medical consultation for the orientation
visit. At Company request, contractor shall provide orientation sessions at Company designated locations.
Contractor will be compensated for those sessions at an agreed rate per session.
3. Medical Care Services

Medical care services shall include routine care, emergency care, emergency transportation, travel health
services and dental referrals.
Routine care shall be accessible during regular office hours or by appointment. Routine care will be
provided in accordance with internationally recognized medical protocols and practices. Routine care will
include medical consultation and treatment, dental referrals, laboratory, radiological and other ancillary
services, counseling and dispensing of medications.
Emergency care shall be accessible round the clock, reachable by phone and should conform to
internationally recognized standards. It shall include stabilization of patients awaiting evacuation and
emergency transportation. Any serious illness, injury or condition resulting in hospitalization requires
Company notification (Medical Providers Handbook, Section 3.1 & 3.3)
Travel health services shall be accessible during regular office hours or by appointment. This shall include
a briefing or information session, immunizations and provision of appropriate prophylactics in accordance
with the travel health plan provided by the Company .
4. Occupational Health Services

Occupational health services shall include fitness-for-work assessments, medical surveillance examinations,
clinical management of work-related injuries and illnesses, examinations or health inspections required by
regulatory agencies or Company policy.
Fitness for Work: Contractor will perform fitness for work examinations and notifications in accordance
with Company procedures (see Medical Providers Handbook, Examination Protocols and Questionnaires,
Sections 4 & 5). This may include pre-employment examinations, testing of food handlers, professional
drivers, alcohol and drug policy compliance (ADU). Company will provide Contractor with instruction in
ADU specimen collection and shipping requirements and Medical Review Officer (MRO) responsibilities.
Contractor will be compensated for ADU support services at an agreed rate.
Medical Surveillance: Contractor will perform medical surveillance examinations and tests, including
audiometry, and carry out notifications in accordance with Company procedures (Medical Providers
Handbook; Section 4)
Clinical Management of Work-Related Injuries and Illnesses: Contractor will provide medical care for
work-related injury and illnesses in accordance with internationally recognized standards. Company will
provide Contractor with occupational exposure information on request (e.g. MSDS). Contractor will follow
Company procedures for examination and notification (Medical Providers Handbook; Section 3).
Examinations required by local regulations or Company policy: Mandatory, periodic examinations will
be performed by Contractor in accordance with local regulations and Company procedures (Medical
Providers Handbook, Section 4).
Health inspection required by local regulations or Company policy: Contractor will perform health
inspections, upon request, on Company premises or Company contractors' premises in accordance with
Company procedures and local laws (Inspection Guidelines for Remote Sites; Medical Providers Handbook,
Section 12.0).
5. Required Protocols
Contractor will present for company approval protocol regarding the under listed subjects and ensure adherence.
• Malaria case management, including diagnostic rapid testing with ( Parasight- F)
• Rabies exposure management including regime for pre and post-exposure immunizations and hyper-
immuneglobulins therapy
• Emergency management of cardiovascular disease, including thrombolytic therapy
6. Notification Requirements
Contractor shall notify Company in event of any of the following:
• Employee hospitalization for observation or treatment.
• Employee with diagnosis considered as part of the Sentinel Surveillance System (SSS) ( paragraph 12
below)
• Employee with condition(s) that will impair fitness for work
Contractor shall notify employee (during exams required by employer) of any abnormal findings that do not
impact fitness for work (see Medical Providers Handbook, Section 3.2).
7. Emergency Response
For all medical emergencies, Contractor shall follow Company Medical Emergency Response Plan and
notification procedures and shall seek the support of Exxon's Global Medical Assistance Company (Medical
Emergency Response Plan; Medical Providers Handbook, Section 3.3).
8. Quality Assurance (QA) Program

Contractor will facilitate and comply with Company's QA program. This includes self and external assessments
of contractor's facilities, records and patient management practices. ( see Medical Providers Handbook, Section
11)
9. Health Education and Awareness

Contractor will develop educational material and provide educational sessions to Company employees regarding
local public health concerns and preventative practices. The educational material will be in accordance with
Company prevention programs for public health risks
10. First Responder Training

Contractor will organize certified instructors to provide First Aid and CPR training to personnel selected by
Company. Training will be in accordance with internationally recognized protocols as obtainable from Red
Cross First Aid and U.S. Basic Life Support training program.
-2 -
11. Medical Records Keeping and Transfer of Medical Records
Contractor will maintain Company and personal medical records in separate files, in a confidential manner at its
facility location. Company medical records will include results from all Company required medical evaluations
and work-related injuries and illnesses. Upon employee's authorization, contractor will release a copy of the
employee's medical files, in accordance with Company procedure for transfer of medical records (Medical
Providers Handbook; Section 10). Contractor will keep Company medical records for duration fixed by
Company.
12. Health Reporting System (HRS)

Company will provide Contractor with Company Health reporting forms and instructions manual. Contractor
will comply with the HRS procedures described in Company HRS instructions booklet and with SSS protocols
(Medical Providers Handbook; Section 8).
13. Malpractice Insurance.

Contractor shall maintain an adequate malpractice insurance coverage for the complete scope of this agreement.
14 Blood Borne Pathogen Control program

Contractor will follow procedures for the control of blood borne pathogens meeting the requirements outlined in
E&P Forum's "Guidelines for the Control of Blood Borne Pathogens in the E&P Industry" ( see Medical
Providers Handbook, Section 9)
15 Reimbursement for Medical Services

Company agrees, guarantee payment for reasonable medical costs incurred for medical care under this
agreement. However, in situations where the estimated cost of non-emergency medical services would exceed
USD 10,000.00, Contractor should seek prior Company approval
-3 -
Medicine and Occupational Health
Dear traveler,
Recently you have booked a flight to a country where malaria is a health risk. Malaria is a
preventable disease, however if contracted, it can be serious and potentially fatal if not diagnosed
and treated properly. Malaria may represent a risk according to your destination and in-country
travel plans and we would like to ensure that all travelers to malarious areas are equipped with the
proper information and preventive medication. The expectation of the corporation is that all travelers
to malaria risk areas, comply with MOH recommendations for malaria prevention .
If you are an employee,

you can find generic health information on your travel destination on the ExxonMobil Travel Health
intranet site. Click on [Click Here ]. Click on Destination Information and choose your country of
destination. This site has current information on health risks and the recommended health
prevention measures at your destination. However, it does not replace the advice of a travel health
consultant.
Therefore, before you depart, please make an appointment with the closest ExxonMobil clinic or
contact your regional travel health consultant. The travel health consultant will provide you with
precise information on malaria risk at your destination and training on how to avoid malaria. He or
she will provide or prescribe a prophylactic medication which is appropriate for you and advise you
on what steps you should take, should you become infected. If you visit an ExxonMobil clinic, you
will also receive a medical kit with several over the counter drugs for minor common travel health
ailments and an EMERS card.
As you know, the best treatment is prevention. Without protection, you might expose yourself to a
serious health risk. Even if you are familiar with the country you are traveling to, call the clinic.
Preventive measures and recommendations change with time and it is important to verify that your
information about malaria is current and accurate.
Travelers to Chad and Cameroon, are required to participate in the Malaria Chemoprophylaxis
Compliance Program (MCCP). Those travelers will receive a training package on MCCP and will
have to sign an attestation form, registering them in the malaria prophylaxis testing program. For
more information on the MCCP, please contact K. Moynihan (281-654-2319)
If you are a contractor,

Contact your company medical professional to obtain information, advice and preventive medication
to protect you against malaria infection during your trip.
Several travel health web sites including the U.S. Centers for Disease Control (CDC) and the World
Health Organization (WHO) web sites provide reliable information on malaria prevention,.
Bon voyage.
Job OBServations
Program
Job OBServations for

Malaria Prevention
Looking out for each other
Contents
Introduction .............................................................................................. 1
Unit 1 - Introduction to Cause and Prevention of Malaria................... 4
Unit 2 - Understanding Job Observations for Malaria Prevention ..... 20
Unit 3 - Doing Job Observations for Malaria Prevention..................... 50

Why do I need this book?
Values and Beliefs This book will help you:
• understand how important controlling malaria is to our company

SAFETY AND Continuous
• learn how to do job observations - to keep you and others safe
HEALTH from the malaria disease
Improvement
First in in Business
All We Do
Performance
Caring
About
PEOPLE ExxonMobil believes that health and safety are a top priority. We
want to do business in a way that protects our workers from contracting
Protecting INTEGRITY the malaria disease.
the Natural in All Our
ENVIRONMENT Job OBServations (JOBS) for malaria control help us do that. They
Actions help us:
• look out for each other

• learn what's both safe (i.e., wearing long sleeves) and at risk
We Believe (i.e., not applying insect repellent to exposed skin) at our job sites
• make things safer for people
...Accidents, injuries, and malaria incidents are preventable, both on and off the
job.
...No business objective is so important that it will be pursued at the sacrifice of

safety.
...Anyone in the workplace who observes an action or conditions that is at risk has
an obligation to intervene and address the root causes inherent in the process.
...In continuous improvement of safety and health in everything we do.
Job OBServations help us look out for each other.
1 2
How do I use this book: Unit 1
The three main units in this book are:
• Introduction to cause and prevention of malaria

Introduction to Cause and
•
•
Understanding Job OBServations (JOBS)
Doing Job OBServations (JOBS)
Prevention of Malaria
You'll likely use this book, at first, as part of a training session. That might
be in a classroom, or it might be a one-on-one session. In either case you
should be led through the book's content. At points in the book you'll be
asked to test yourself on what you learn.
Once you know this book's content keep it close by. For example, you
might keep it in the glove box of your vehicle. This book's size should
make it easy to carry with you at all times.
Unit 1 - Introduction to cause and prevention of malaria. This unit will

show you what is malaria, how we contract malaria, and what prevention to
use against malaria.
Unit 2 - Understand JOBS for malaria prevention. Here you'll learn

about our company's health and safety policy - what it says and what it
means. You'll also learn about the types of incident causes and the model
used for our safety management system. (Job observations are a very
important part of that system.) Finally, you'll be introduced to doing JOBS
yourself.
Unit 3 - Doing JOBS for malaria prevention. This unit shows you the
five-step method for doing JOBS. You'll learn about the JOBS card - a tool
for doing job observations and learning from them. You'll learn to tell how
safe or at risk something is. Finally, you'll learn what potential incident Job OBServations for malaria prevention
causes to look for in the areas of work environment, management systems, Looking out for each other
and human behaviors.
JOBS are an important part of our safety

management system.
3 4
What do you know about Malaria?
Unit 1:
How to Avoid Malaria: 1. Malaria is the #1 health risk in Africa True False
Public Health Enemy #1 2. Malaria can be fatal within a few hours
of symptoms True False
3. The most effective way to prevent malaria
is to avoid being bitten by mosquitoes True False
4. Bed nets with holes protect you from bites
while you are sleeping True False
5. Most people suffer serious side effects
from taking anti-malarial drugs True False
6. Fever is the only symptom which indicates
that you may have malaria True False
Malaria is transmitted to people by infected mosquitoes. This training will Answer these true/false statements to see what you know about malaria. By
teach you how to avoid contracting malaria, which can be a fatal disease. the end of this training you will be able to correctly answer all of these
statements.
The answers are located on the last page of this unit if you'd like to check
how well you did.
5 6
Malaria is a Health Risk Safety and Health Goals
• #1 Health Risk in Africa
• No incidents
– Angola - Chad -Cameroon
– Congo - Equatorial Guinea • No malaria cases
– Nigeria
• South America
• Southeast Asia
• Most tropical diseases are rare
except for Malaria!
Malaria is a health risk in some locations where we operate, explore, and Our company safety goal is to have "0" incidents. Likewise our health goal
develop. Malaria is the number one health risk in Africa, especially in is to have "0" malaria cases. This is a challenge but as you will learn in the
Angola, Chad, Cameroon, Congo, Equatorial Guinea, and Nigeria. It is next few minutes, your behavior can help us achieve this health goal.
more moderate risk in areas of South America and Southeast Asia.
There are many tropical diseases, but they are rare compared to Malaria.
7 8
What is Malaria? Relative Odds
• A disease transmitted by infected mosquitoes
Visitor to a Cameroon survey camp clinic being
• ExxonMobil’s highest health risk for expats in Africa diagnosed with Malaria 1 1 in 5
• Severe cases can result in death within a few hours
• Disease can be avoided by not being bitten Hitting a jackpot on a slot machine 2 1 in 889
Dying while hospitalized with a case of malaria 3 1 in 2,000
• If bitten, parasites transmitted into your body can be killed
Giving birth to triplets 2 1 in 9,997
by preventative medicine in your bloodstream
Dying from a poisonous snake bite in United States 4 1 in 268,153
• If bitten by an infected mosquito and you have not taken Being struck by lightning 2 1 in 606,944
the preventative medicine you will contract malaria Winning the New Jersey lottery (May 5, 2000) 2 1 in 76,000,000
• Untreated Falciparum malaria can kill you
• Falciparum malaria is very common in West Africa 1 Health Reporting System
2 The Odds on Virtually Everything
3 Dr. Jean-Marie Moreau
4 U.S. National Safety Council
Malaria is a disease transmitted by infected mosquitoes. If you are on Here are some odds related to contracting and dying from malaria. Our
expatriate assignment in Africa, malaria is the number 1 health risk. company data indicate that one out of every five visits to a clinic at a
Malaria can be fatal and if severe, death could result in just hours. Cameroon survey camp was a malaria case. If you are hospitalized with
malaria, you have a .05% chance of dying from the disease, even if the
You can entirely avoid malaria by not being bitten by mosquitoes. This hospital is well equipped.
involves following recommended practices such as using insect repellent.
Another precaution is to take preventative medicine - an antimalarial drug
to prevent malaria if you are bitten.
There are several types of malaria. The most serious case is caused by the
Falciparum parasite that is transmitted by the female Anopholes mosquito.
This serious type of malaria is very common in West Africa.
9 10
Malaria Glossary You can avoid contracting
• Anopholes Mosquito variety of mosquito that carries the malaria
Malaria by:
parasites - the females bite after dusk
• Falciparum -one of 4 types of parasites transmitted by mosquitoes that • Avoiding mosquitoes and mosquito bites
cause malaria. Untreated Falciparum malaria can kill you.
• DEET (30% N, N-diethyl-m-toluamide) the most effective mosquito repellent for
• Taking your preventative medicine
application on exposed skin • Using a bed net
• Permethrin  commercial name for the most effective mosquito
repellent for application to clothing and bed nets. • Using skin insect repellents
• Chemoprophylaxis preventive medication - (e.g., antimalarial drug) - • Wearing long sleeves, pants
taken on the advice of Medical Doctor or Registered Nurse
• Chloroquine- about 50% of malaria parasites are resistant to this
antimalarial drug. Resistance is widespread
• Larium -commercial name for Mefloquine, the most effective and mo
commonly prescribed antimalarial drug
These are common terms associated with malaria. Important points are: These behaviors are keys to avoiding malaria because they minimize the
chance that you will be bitten by mosquitoes. All of these behaviors are
• The mosquito bites after dusk. Therefore, bite prevention is most your responsibility both on and off the job. Avoiding mosquito bites should
important during the evening hours. Particular attention should be be part of your work and lifestyle habits. Taking the preventative medicine
focussed on protecting yourself while sleeping in quarters, or camps, ensures that if you are bitten you don't contract malaria. Avoiding bites
and during outdoor evening activities. together with taking preventative medicine is the only way to effectively
protect yourself from contracting malaria. A bed net protects you from
• DEET is the recommended repellent to apply to your skin.
mosquito bites while you are asleep. You should treat the bed net with
• Permethrin is the recommended repellent to apply to your clothing. Permethrin and inspect it regularly for holes and tears. DEET is the
• A chemoprophylaxis is a preventative medicine. There are various recommended repellent for skin. Long sleeves and pants are recommended
antimalarial drugs which must be taken according to prescription in because it is more difficult for mosquitoes to bite through fabric.
order to be effective. Larium is the most commonly prescribed drug.
• Research indicates that severe side effects from taking antimalarial
drugs are extremely rare. If you do experience side effects, they are
likely to be mild and peak at about the third week into taking the drug.
11 12
You can reduce the severity of Malaria Symptoms
Malaria by:
Initial Signs Cerebral Malaria
• Recognizing symptoms • Fever • Consequence of severe malaria
• Headache • Irritability
• Obtaining prompt medical treatment • Sweats and Chills • Confusion
• Pain in the back and limbs • Convulsions
• Fatigue • Coma
• Cough
• Diarrhea
• Nausea and vomiting
If you contract malaria, it is critical that you get prompt medical treatment. Here are symptoms of malaria. You'll notice that they vary widely and can
You should also be able to recognize symptoms so that the malaria can be also be as vague as "feeling unwell". Therefore, it is important that you
treated before it develops into a severe case. promptly request medical evaluation if you experience these symptoms.
13 14
Defenses Against Malaria Defenses Against Malaria
Infected Infected
Mosquito Mosquito
Work Environment Work Environment

•eliminate standing water
•screens over windows
•mosquito breeding control
Malaria •prevention of mosquitoes in quarters
Malaria
Management Systems Case Management Systems Case
•malaria prevention training
•pre-job malaria prevention review
•JOBs malaria prevention program
Personal Protection Personal Protection
•wear repellent
Preventative •take precautions after dusk
•use bed nets Preventative
Medicine •wear treated clothing
Medicine
•take antimalarial drugs as
Human Behavior Human Behavior
prescribed
This is a summary of the defenses called "safety filters" that are put in place This chart details the practices and procedures for each of the 3 filter types.
to protect you from a case of malaria. There are 3 types of filters: (1) work
environment, (2) management systems, and (3) human behaviors. These Note that although work environment and management systems are in
filters together protect you from malaria. Holes in the filters increase your place, the human behavior defense is still required to prevent malaria cases.
potential of contracting malaria. Not following procedures for personal protection from mosquito bites or not
taking preventative medicine are holes in your filters against malaria.
Note that the human behaviors consist of.
• Personal protection from mosquito bites

and
• Taking preventive medicine.
15 16
Your behavior prevents Malaria Expected Malaria Prevention
Behaviors
• Defenses that reduce most risk
– Prevent mosquito bites AND • Wear insect repellent • Report conditions at work sites,
• Take extra precautions after camps, residences and
– Take preventative medicine accommodations that need
dusk - especially pants and
long-sleeves improvement
• Preventative medicine alone is not preferred • Help and remind others to use
• Take preventative medicine as
– Treatment not 100% effective prescribed behaviors
– Symptoms easily overlooked or recognized too late • Wear treated clothing • Practice behaviors off-site
– Possible misdiagnosis • Use treated bed nets • Monitor dependents’ behaviors
– Self diagnosis and treatment is very risky • Report any malaria-like • Participate in JOBS behavior
symptoms observation
• Work site mosquito control contributes to risk reduction,

but not a primary defense
Of these 3 categories of defenses, human behavior can reduce the most risk For each individual in our work site, these are the expected behaviors for
of malaria. preventing malaria. Your behavior will determine if we meet the goal of
"0" malaria cases. We are implementing a field observation/interview
There are many reasons why taking preventative medicine without avoiding program to help us monitor and improve compliance with these behaviors.
bites is not preferred (see list above). This program is called JOBs and will be covered in the next unit.
Please share this Malaria Prevention Training with your family and practice
malaria prevention off-site as well.
17 18
Unit 2
What do you know about Malaria?
1. Malaria is the #1 health risk in Africa True False

Understanding Job OBServations
2. Malaria can be fatal within a few hours
of symptoms True False
for Malaria Prevention
3. The most effective way to prevent malaria
is to avoid being bitten by mosquitoes True False
4. Bed nets with holes protect you from bites
while you are sleeping True False
5. Most people suffer serious side effects
from taking anti-malarial drugs True False
6. Fever is the only symptom which indicates
that you may have malaria True False
Job OBServations for malaria prevention

19 20
ExxonMobil Safety Credo We Believe
SAFETY
• We the Management and Employees of ExxonMobil
believe that while risks exist: ...Accidents, injuries, and malaria incidents are preventable,
both on and off the job.
• Accidents and injuries are preventable.
...No business objective is so important that it will be
• Each of us has a personal responsibility for our pursued at the sacrifice of safety.
safety and the safety of others, both on and off the
...Anyone in the workplace who observe an action or
job.
condition that is at risk has an obligation to intervene
and address the root causes inherent in the process.
• No business objective is so important that it will be
pursued at the sacrifice of safety. ...In continuous improvement of safety in everything we do.
• Safe conduct of operations is a condition of People's health and safety are very important to us. We don't want
employment. anyone to take unnecessary risks - not for cost savings, not for production
gains, not for any reason! We don't want anyone to be hurt or get sick at
any time.
• A job is well done only if it is done safely.
We have a very good safety record. It's one of the best for oil and gas
companies, however, we want to be even safer. That's the challenge!
• We should have the best safety performance in the
industries in which we do business.
We don't want anyone to take unnecessary risks - not for any reason! Everyone has an obligation be involved in safety.
21 22
How important is safety to our company? What is an incident? A potential
incident?
Safety is part of doing business.
An incident is when either:
• someone is actually hurt (i.e., bitten
by a mosquito carrying the
malaria disease)
• something is actually released or
property damaged
and or An incident causes immediate or
long-term harm.
A potential incident is when either:

• someone could have been hurt
• something could have been lost or damaged
In our company, we manage safety as our number one priority. Our safety Incidents include:
management system works with other management systems to achieve
business results. All systems that support cost savings and production gains • serious injuries where a worker requires medical treatment or must
are never more important than safety. take time off work to recover (i.e., worker contracted malaria)
• minor incidents that may include injuries treated with first aid on
Work, like everything else we do in life, has some risks. We can't get rid of
the job
all risks, but we can reduce them. Keeping safe by lowering risk is how we
work! Lowering risks by watching for potential incidents will stop actual • damage to equipment or facilities
incidents. • product losses, including spills and other releases
Anyone on the workplace who observes an action or condition that is unsafe Potential incidents include:
has an obligation to intervene.
• a hazard. This is when we see something that could lead to an
injury, loss or damage.
• a near miss. Unexpected or undesirable event that could have
resulted in injury or loss under slightly different conditions.
• anything that might cause an incident (e.g., an at risk behavior such
as not using insect repellent on exposed skin).
No business objective is so important

That it will be pursued at the sacrifice of safety. An incident causes immediate or long-term harm.
23 24
What causes malaria incidents? Can a malaria incident have more
The types of incident causes are:
than one cause?
Yes. Different people can affect incident causes.
• work environment
• management systems
• human behaviors
Many things can cause malaria incidents. Cause types are: In the past we thought incidents were only caused by a single unsafe work
environment condition or human behavior. Because of that, we didn't look
Work environment. Our safety is affected by all the things around us much past the environmental condition or the person doing the job.
when we work. These include the condition and design of areas where we
work and live. Work environment encompasses both the work and living We now know that incidents can have many causes found in one or more of
areas. the cause types.
Management systems. We have a number of inter-related management Managers control management systems and sometimes work environment,
systems for achieving business results. All include standard, processes and but if something you can't control is unsafe, tell someone. Everyone shares
procedures for getting those results - while keeping people safe. responsibilities to work within the systems and maintain a safe work
environment.
Human behaviors. How we act on and off the job affects everyone's
safety. Behaviors include using the right malaria medication and taking In other words, everybody is responsible for their own and others' safety.
precautions to stop a mosquito infected with-malaria from biting us. The We all share in reducing risk to prevent malaria incidents. You control your
way people talk about the importance of safety - and how often - is another behavior!
human behavior.
Behaviors are usually easier to observe than other incident-cause types.
Incident causes are working conditions, management systems, Everybody is responsible for their own and others' safety.
and human behaviors.
25 26
Are all malaria incident-cause What have been the key points so far?
types equal?
• Job OBServations help us look out for each other.
Let's look at an example of contracting malaria. • JOBS are an important part of our safety management system.
• We don't want anyone to take unnecessary risks - not for any
reason!
• Everyone has an obligation to be involved in safety.
• No business objective is so important that it will be pursued at
the sacrifice of safety.
• An incident causes immediate or long-term harm.
• Malaria incident causes are work environment, management
systems, and human behaviors.
• Everybody is responsible for their own and others' safety.
• Malaria incident may often be caused by management systems
and their use.
In this photo, a mosquito has landed on exposed skin. A worker in

the field did not:
• have on a shirt with long sleeves
In the past, we might have thought of that as a single, unsafe human Job OBServations for malaria prevention
behavior - not wearing long sleeves - combined with a single, unsafe work
environment - surrounded by standing puddles. But let's think about that a Looking out for each other
little more. Were there other causes?
With further thought we see that causes might also be in management

systems. For example:
• had the workers received the proper awareness and malaria training
on expected critical safe behavior
• procurement keep standard list of items stocked
27 28
What have I learned? How much do I now know about:
Think about what you've learned so far. Take some notes to help • Our company's commitment to safety?
you remember.
• Our company's safety performance?
• What incidents are and what causes them?
_______________________________________________________ • Who's responsible for safety?

_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________ Safety
_______________________________________________________ Manual
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________ Circle True or False for what you think is the right answer.
_______________________________________________________
_______________________________________________________ 1. Our safety performance is as good as it can be. True False
_______________________________________________________
_______________________________________________________ 2. Only managers are responsible for safety. True False
_______________________________________________________
_______________________________________________________ 3. We do not want anybody contracting malaria True False
at any time.
4. Production is more important than safety. True False

What is the key point for you? Write it here.
5. An incident is when somebody is hurt or something True False
is released or property damaged.
6. Incidents only have one cause. True False
The answers are on the next page.
29 30
How well did I do? So what - exactly - are Job OBServations?
1. Our safety performance is as good as it can be. True False Job OBServations are watching another person do a job -
to find out what's safe and what's at risk.
2. Only managers are responsible for safety. True False
3. We do not want anybody contracting True False

malaria at any time.
4. Production is more important than safety. True False
5. An incident is when somebody is hurt or True False

something is released or property damaged.
6. Incidents only have on cause. True False
Answers are explained here: JOBS provide a method for making us safer. They help us:
1. We have a good safety record. But we want to be even safer. • Identify potential incident causes
• Encourage safe behaviors
2. Everyone is responsible for safety. Managers control management
systems and sometimes work environment, but if something you can't • Learn safe behaviors from those we observe
control is at risk, tell someone. Everyone shares responsibilities to work • Learn which work environment and management systems work well
within the systems and maintain safe work environment.
Looking for what's already safe, as well as what's at risk, helps us
3. We want to prevent all malaria incidents. Keeping safe by reducing risk understand what we're doing right so we can do it again.
is how we work.
Anyone at a job site can observe anyone else. The observer, however,
4. No business objective is so important that it will be pursued at the must stop long enough to clearly see what's happening. The observer
sacrifice of safety. then gives feedback - right away! In doing that, we want to feed back on
the good things we see (i.e., wearing long sleeves), as well as the bad
5. An incident has happened when somebody is actually hurt or something (i.e., window/door screens have holes). If you think about it, we already
is released or property damaged. Incidents can cause immediate or long- have a good safety record. So we should have lots of good things to say.
term harm. Near misses and hazards are potential incidents. Work
environment, management systems and unsafe behaviors, are also only
potential incidents - until something actually happens.
6. Each incident can have many causes. Incident causes may often be
traced back to management systems and their use.
Job observations help us see what's safe and at risk.
31 32
So what do I look for? So what - more specifically - do I look
for in a malaria incident?
Work on
Work Environment
the job site
Work Environment
Infected Mosquito • window screens with holes
Management Systems
Management Systems
• no malaria awareness training
• no written procedures
Human Behaviors
Human Behaviors
• not taking chemoprophylactic drug
• not using insect repellent
Malaria Incident! Malaria Incident!
The picture shows safety filters between the work and the incident. Some Let's think about a worker who contracts malaria:
of them have holes we need to fill to stop incidents.
• was bitten by a malaria-infected mosquito
Workers' not using insect repellent might be a hole in human-behavior
filters. Not having window screens might be a hole in work environment • did not apply insect repellent to exposed skin
filters. We might need to fill more than one hole in more than one filter -
to be safer. Work environment filters. Was insect repellent available from the on
site supply department? Was insect repellent readily available to use at
the work site?
Looking at safety filters is another way of saying looking out for each other.
Filling holes means affecting an incident's causes. If we can't change a Management system filters. Did the worker receive awareness and
cause, we can still reduce risk by remembering incidents can have more malaria training on expected critical safe behavior? Were procedures
than one cause. For example, if we can't dry standing puddles (a work developed to include consideration for malaria hazard?
environment) we can use insect repellent (a human behavior).
Human behavior filters. This worker did not apply insect repellent to
exposed skin. Did the worker simply choose not to apply the insect
repellent?
We must think about all of those possible causes in trying to be safer.

Once we know the causes we can fill holes in safety filters. That's how
we can reduce the risks and the chances of incidents occurring.
Safety filters exist between the work and an incident. Once we know an incident's causes we can fill holes in
safety filters.
33 34
How are malaria incidents stopped? What have been the key points since
What are we doing about them? the last review?
Incident stopped by
improved work • Job observations for malaria prevention help us see what's
Infected Mosquito environment safe and at risk.
Incident stopped through
Improved human
behaviors
• Safety filters exist between us and a malaria incident.
• Once we know a malaria incident's causes we can fill holes

in safety filters.
Incident stopped by
improved management
systems No Incidents!
• Our goal is zero malaria incidents.
Malaria incidents are stopped by filling holes in safety filters. That's what
we're trying to do for all our activities. Our vision is a malaria incident free
workplace.
We need to evaluate potential incident data (hazards and at risk behaviors)

to continue to make progress in reducing incidents.
You can help by thinking about your own behaviors - something you
control. Are you acting as safely as you should be? By observing others
you might learn even safer ways of doing things. Job OBServations for malaria prevention
Our vision is zero malaria incidents.
35 36
Think about what you've learned so far. Take some notes to help • what JOBS tell us?
you remember. • incident causes?
• responsibilities for safety?
Infected
Mosquito
Malaria Incident!
_______________________________________________________
_______________________________________________________
_______________________________________________________ 1. Malaria incidents are only caused by True False
_______________________________________________________ the work environment.
_______________________________________________________
2. Malaria incidents are only caused by True False
_______________________________________________________ management systems.
_______________________________________________________
_______________________________________________________ 3. We can help reduce the risk of malaria True False
_______________________________________________________ incidents by knowing the causes.
_______________________________________________________
_______________________________________________________ 4. JOBS only tell us what we're doing wrong. True False
_______________________________________________________
_______________________________________________________ 5. Managers and workers are responsible for True False
_______________________________________________________ safety.
_______________________________________________________
6. We can lower the chances of malaria incidents True False
_______________________________________________________ occurring.
37 38
How well did I do? So how do I change my behavior -
1. Malaria incidents are only caused by True False
if I need to?
the work environment.
Human Behaviors
2. Malaria incidents are only caused by True False The way we act
on and off the job Consequence
management systems. Input
3. We can help reduce the risk of malaria incidents True False A person, place, thing or
by knowing the causes. event coming before a Work Environment Events that follow
behaviors and affect
behavior that encourages
Management Systems the chance that they
us to perform that
4. JOBS only tell us what we're doing wrong. True False behavior
will happen again.
5. Managers and workers are responsible for safety. True False Change
Data
Collection
Collect and analyze
data to continuously
6. We can lower the chances of malaria incidents True False improve.
occurring.
Answers are explained here: A first step is to understand what affects our behavior. Here you see the
safety model used to design our safety management system. This model
1. A malaria incident can have many causes. helps us:
2. Incident causes may be with management systems, but they're not the • find malaria incident causes
only cause. • change things to prevent malaria incidents
3. Knowing causes of malaria incidents helps us fill holes in safety filters. In the safety model, boxes show how behavior is affected by inputs and
consequences.
4. JOBS help us see what we're doing good, as well as bad.
Inputs. The inputs to our behavior are at the left of the picture. The inputs
5. Everybody is responsible for safety. Anyone in the workplace who can be people, places, things or events that affect the way we act. They
observes an action or condition that is at risk has an obligation to include what managers expect and work environment.
intervene.
Human behaviors. Human behaviors are shown at the top of the picture.
6. Malaria incidents can be prevented by: We might act in a way that reduces or increases the risk. Behaviors are
• knowing their causes affected by the inputs, which influence us to act a certain way. They're also
affected by the consequences of our behavior.
• reducing the risk
Consequences. The consequences are shown at the right of the picture. If we
do what we're supposed to do, we might get thanked or rewarded. If we don't,
we might get into trouble. If the consequences make us feel good, we'll likely
do the same things again. If they make us feel bad, we likely won't.
Understanding inputs and consequences affects human behavior.
39 40
More specifically, why do we behave Can I influence others' behavior?
the way we do? Yes.
• People, places, things or events
• Make others feel good about a safe behavior - right away.
that come before we do
something influences us to act the way we do.
• Respond to others' behavior - right away.
• Things that happen after we do
• Intervene if at risk behavior is observed.
something affect the chances
we'll do it again.
The safety model you've been looking at includes inputs and consequences Making others feel good is a consequence. At the very least, congratulate
that affect human behavior. In other words, behavior is affected by what someone on doing a safe job - right away! Making others feel good
comes before and after it. The model also shows the effects of management increases the chances they'll do the same thing next time.
systems and work environment on behavior.
Research shows that we should reinforce good things at least four times
Inputs. A manager's view on safety can be an input, as can rewards or as often as bad things. In other words, we should do much more
correction. Other inputs might be training we've received, the way rewarding than correcting.
equipment is designed, or the standards and procedures we're asked to
follow. Making others feel good helps us get something we want. We want more
safe human behaviors. If we keep reinforcing the good we will begin to
Inputs are changed by learning from consequences. get even more of what we want.
Consequences. Consequences include things like being congratulated, Sometimes, though, you'll have to correct others to avoid future at risk
being hurt or causing an incident. How our managers or coworkers respond behavior. You may even intervene to prevent immediate bad
to our work can also have an effect. Sometimes a simple, "Good safe job!" consequences. But, if you need to do that, talk about the behavior - not
can have a big effect on how we act when we do the same job again the person. Always think of the other person as an ally - someone you're
working with, not against. Thinking that way can make your feedback
stronger.
Inputs are changed by learning from consequences. Influence others' behavior by making them feel good about their
safe behavior.
41 42
So how do I give feedback? Any more feedback tips?
• Talk to people right away and be consistent. • Talk about what we can learn.
• Talk with people - not down to them. • Talk about the incident causes - not the person.
• Listen to people and don't lecture. • Remind people about our company's
commitment to safety.
• Say as much about the good things
as you can
If you need to correct something that's bad, avoid making people defensive. Try to get people talking about how the work could be done more safely.
We want them to learn instead of feeling threatened. Help them see the safe way of doing things. You might say, "There should
be a safer way to do that. Let's see if we can work something out together."
Instead of: "You did that all wrong!" If later you see people using the safer way, remember to congratulate them.
Try saying: "I think there was risk in doing it that way." Also ask questions. For example, if a shirt with long sleeves is not being
worn, ask if people have shirts with long sleeves. Maybe they weren't
Talk with the person observed until they're clear why something was unsafe. wearing it because it was uncomfortable. Maybe using it wasn't covered in
Make sure they agree with a safer way of doing things. Make sure they their safety orientation. Try to find the reason for at risk behaviors.
understand what could have happened.
Watch for views like "it won't happen to me" and "we've always done it that
Instead of: "You must wear a long sleeve shirt." way." Neither of these views can support being unsafe. Remind people that
managers have said they don't want anyone to take unnecessary risks - for
Try saying: "I'm sure glad to see you haven't been bitten by a mosquito. Let's any reason!
talk about way to protect ourselves."
Refer to "I" or "we" first, describing how you feel or think the job might
Also encourage people to ask questions if they're unsure of something. Use the have been done safer. Starting with "You" can be more threatening.
Safety Manual and other management system references if additional help is
needed.
Say as much about the good things as you can. Talk about the incident causes - not the person.
43 44
Can I also affect work environment What have been the key points
and management systems? since the last review?
• Understanding inputs and consequences affect
Human Behaviors human behavior.
The way we act
on and off the job Consequence
Input
• Inputs are changed by learning from consequences.
A person, place, thing or
event coming before a Work Environment Events that follow • Influence others' behavior by making them feel
behaviors and affect
behavior that encourages
Management Systems the chance that they good about their safe behavior.
us to perform that
will happen again.
behavior
• Say as much about the good things as you can.
Data
Change Collection
Collect and analyze
data to continuously • Talk about the incident causes - not the person.
improve.
• JOBS notes help us change work environment and

management systems.
Look at the unshaded middle and bottom boxes of the safety model. Here
you see how our work environment and management systems affect the
inputs, human behaviors, and consequences.
From the consequences we learn what's working well and what's not. What
we learn is collected and analyzed to find safer ways of doing things. That Looking out for each other
helps us change the inputs - where those might lead to at risk behavior.
You've learned that you can affect others' behavior by saying something
good. When you see something that's safe let someone know - right away!
Also let someone know if you see something at risk.
The notes you take when doing JOBS are another way to improve work
environment and management systems. Discussing your findings at regular
safety meetings can also help.
JOBS notes help us improve working conditions and

management systems.
45 46
Think about what you've learned so far. Take some notes to help • why we act the way we do?
you remember.
• how to give feedback?
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________ 1. Inputs and consequences affect behavior. True False
_______________________________________________________
2. Inputs are changed by learning from consequences. True False
_______________________________________________________
_______________________________________________________ 3. We should say more good things than bad. True False
_______________________________________________________
_______________________________________________________ 4. More JOBS for malaria prevention mean reduced True False
risk and improved safety.

47 48
How did I do? Unit 3
1. Inputs and consequences affect behavior. True False
2. Inputs are changed by learning from consequences. True False

Doing Job OBServations
3. We should say more good things than bad. True False
for Malaria Prevention
4. More JOBS for malaria prevention mean reduced True False
risk and improved safety.
1. Inputs - people, places, things and events that come before we do

something - affect the way we act. Consequences - what happens after
we've done something - affect the chances that we'll do it again.
2. Our safety model shows that we collect data from the consequences,
learn from it and then change the inputs. That's how we keep getting
safer.
3. We can never really say enough about good things. Doing so leads to
more good things.
4. More JOBS for malaria prevention will lead to fewer incidents.

49 50
The JOBS card is discussed in this unit. This is what
the front of the card looks like. How do I do JOBS?
JOBS Observation Checklist
P O I N T
plan observe inform note track 1. Plan
Safe 1. Work Environment At
Risk 2. Observe
1.1 Window/door screened
and free from holes 3. Inform
1.2 Repellent is located where
it is readily available 4. Note
1.3 Laundry treats/washes clothing/
bed nets with recommended 5. Track
insecticide/repellent Permethrin
1.4 Provides/replaces bed nets
free from holes
1.5 Standing puddles
Plan. Decide when you are going to do the observations/interviews. Set a
1.6 Other areas where insects goal to do so many a day, a week, or a month. Agree with your
could enter are blocked/sealed supervisor/manager/medical department on how many you need to do.
2. Management Systems
2.1 Awareness and malaria Observe/Interview. Ensure that the person observed/interviewed knows
training on expected critical why he/she being observed/interviewed by you. The benefits of this
safe behavior process will be covered in the Awareness training program. The
2.2 Procedures include observation/interview process will cover your dependents and/or co-
consideration for malaria hazard workers. Make sure you watch carefully and in a systematic way for critical
behaviors. The observation/interview checklist (OIC) card can help you.
2.3 Procurement keeps standard
list of items stocked
Inform. After observing/interviewing human behavior (i.e., dependent,
3. Human Behaviors coworker), be sure to comment on the good things you see/hear (i.e., taking
3.1 Chemoprophylactic drug taken chemoprophylactic drug; applying insect repellant on exposed skin). If you
saw/heard any at risk behavior talk to the person until they understand what
3.2 Treated bed net used
could happen. After observing a work environment/ working condition (i.e.,
3.3 Insecticide/repellent screens/nets with holes), be sure to report it immediately to the proper
Permethrin applied to clothes channels for fixing.
3.4 Insect repellent applied to
exposed skin Note. Make notes on the OIC card.
3.5 Uses extra precaution (long
sleeves, light colored clothing) Track. Pass the OIC card to whoever's collecting them (e.g., medical, your
supervisor). We can analyze data for what's working well and what needs
3.6 Limits outside activity after dusk improving.
3.7 Reports any malaria-like symptoms
POINT to everything that's safe and unsafe. Make sure you POINT
3.8 Being treated for malaria to malaria causes - not people.
3.9 Provides information on the
HRS form at clinic visit To do JOB: Plan, Observe, Inform, Note and Track.
51 52
How do I use the JOBS card? How do I complete the back of the JOBS card?
Use the JOBS card to help you look for holes in safety filters. Company/Contractor _____________ National/Expat ______________
Site______________________ Work Observed_______________
What was observed? What was said? What is to be done?
Infected (R/C) Reinforcement/Correction
Work Environment
Mosquito __________________ ( )______________ __________________
__________________ ( )______________ __________________
Management Systems
__________________ ( )______________ __________________
__________________ ( )______________ __________________
Human Behaviors
__________________ ( )______________ __________________
__________________ ( )______________ __________________
__________________ ( )______________ __________________
Malaria Incident!
Any change in behavior during observation? Yes No
Observer Name (print) ___________________ Date________________
The JOBS card helps you do job observations in a systematic way. It Here you see the back of the JOBS card. This is where you’ll note what you
reminds you: observed and said to the person observed. You’ll also note any suggested
follow-up (things we need to improve). The name of the person you
! of malaria incident causes to look for watched/interviewed does not go on the card.
! to look for both safe and at risk conditions or behaviors.
Check if someone’s behavior changed because of the observation. That often
The card also gives you places to note your learnings and comments. happens, for example, if they were doing something unsafely and knew they
were being watched. The kinds of things people might doing during the first
On the front of the card check results of your observations. On the few seconds you watch them are:
back of the card note anything that could make us safer. That will
give us data for improving work environment, management systems, ! spraying exposed skin with insect repellent
and inputs to human behaviors. ! adjusting personal protective equipment
! reorganizing the work
In assessing risks, remember, nothing is really 100% safe or 100% at
risk. Consider both the probability of a malaria incident occurring Note if intervention occurred.
and the severity of consequences if an incident does occur.
The JOBS card helps you do job observations in a systematic way. Notes on the JOBS card help us learn what we need to improve.
53 54
How well do I observe now? What else have I observed?
Let’s see. Can you name the malaria incident-cause types? The answers Can you complete the following JOBS steps? The answers are in this book
are in this book – if you’ve been observing. – if you’ve been observing.
1. P _________
Work
on the
Conditions
2. O_________
job site
Systems
Behaviors
3. I _________
4. N _________
5. T _________
Incident!
Job OBServations Job OBServations

Looking out for each other Looking out for each other
Job Observations are a very important part of our safety Job Observations are a very important part of our safety
management systems. management systems.
55 56
What work environment critical JOBS Observation Checklist
P O I N T
issues should I especially watch for? Plan observe inform note track
Risk
Work on
Work Environment
the job site Filter
1.1 Window/door screened
and free from holes
Management Systems
it is readily available
Human Behaviors
bed nets with recommended
Malaria Incident!
free from holes
1.6 Other areas where insects
could enter are blocked/sealed
Work environment critical issues that often cause malaria Keeping the mosquitoes out is one way to prevent a bite. On the
incidents are: job, keep the windows and doors closed to prevent the mosquitoes
from entering the premises. Look at the screens on the windows and
! Window/door screened and free from holes doors and make sure they are free from holes. If one of these
screens need to be replaced, follow the procedure to obtain a
! Repellent is located where it is readily available replacement. Can you obtain a new screen? If not, what can you do
to remedy the problem?
! Laundry treats/washes clothing/bed nets with recommended
! Provides/replaces bed nets free from holes Observe Work Environment. Note here any risk experience:
window/door screened and free from holes. Share these with your
! Standing puddles training class.
! Other areas where insects could enter are blocked/sealed Safe: __________________________________________
__________________________________________
Work environment critical issues combine the design, construction and
maintenance of facilities and tools as they effect the inherent safety of the At risk: ___________________________________________
workplace.
Learn to watch for malaria incident causes in the

work environment.
57 58
JOBS Observation Checklist JOBS Observation Checklist
P O I N T P O I N T
plan observe inform note track plan observe inform note track
Safe 1. Work Environment At Safe 1. Work Environment At
Risk Risk
1.1 Window/door screened 1.1 Window/door screened
and free from holes and free from holes
Filter
1.2 Repellent is located where 1.2 Repellent is located where
it is readily available it is readily available
1.3 Laundry treats/washes clothing/ 1.3 Laundry treats/washes clothing/
Filter
bed nets with recommended bed nets with recommended
insecticide/repellent Permethrin insecticide/repellent Permethrin
1.4 Provides/replaces bed nets 1.4 Provides/replaces bed nets
free from holes free from holes
1.5 Standing puddles 1.5 Standing puddles
1.6 Other areas where insects 1.6 Other areas where insects
could enter are blocked/sealed could enter are blocked/sealed
Applying insect repellent to exposed skin is one of the most The repellent Permethrin can only be applied to fabric. Using the
important things you can do. It helps to keep the mosquitoes and repellent is another step to avoid being bitten by mosquitoes. It can
other disease carrying insects away. The application of the provide protection for weeks and through many detergent
repellent may need to be repeated several times during the day washings. It does not emit fumes or vapors and is very safe to use.
especially during outdoor activities such as jogging and walking When was the last time your outer clothing and bed nets were
through vegetation, as perspiration lessens its effect. treated with Permethrin? Did you apply the treatment or was it
done at the laundry service?
Can you easily access the repellent? If not, follow the procedures
to remedy the situation.
Observe Work Environment. Note here any risk experience: Observe Work Environment. Note here any risk experience:
repellent is located where it is readily available. Share these with laundry treats/washes clothing/bed nets with recommended
your training class. insecticide/repellent Permethrin. Share these with your training
class.
Safe: __________________________________________
__________________________________________ Safe: __________________________________________
__________________________________________
At risk: ___________________________________________
At risk:
59 60
JOBS Observation Checklist JOBS Observation Checklist
P O I N T P O I N T
plan observe inform note track plan observe inform note track
Safe 1. Work Environment At Safe 1. Work Environment At
Risk Risk
1.1 Window/door screened 1.1 Window/door screened
and free from holes and free from holes
1.2 Repellent is located where 1.2 Repellent is located where
it is readily available it is readily available
1.3 Laundry treats/washes clothing/ 1.3 Laundry treats/washes clothing/
bed nets with recommended bed nets with recommended
insecticide/repellent Permethrin insecticide/repellent Permethrin
Filter 1.4 Provides/replaces bed nets 1.4 Provides/replaces bed nets
free from holes free from holes
1.5 Standing puddles Filter 1.5 Standing puddles
1.6 Other areas where insects 1.6 Other areas where insects
could enter are blocked/sealed could enter are blocked/sealed
The bed nets are another step in preventing being bitten by Mosquitoes breed in standing water which includes water on the
mosquitoes and becoming ill. It is very important to check the bed ground, in empty cans and tires, flowerpots and any other object
nets used in your home. If one needs to be replaced, follow the that holds water. Breeding is very high during the rainy season.
proper procedure to obtain a new one. Are they readily available Stopping the mosquito from breeding helps to prevent illness.
to you? Can you obtain one quickly?
Have you seen any standing puddles within your work area? If
so, follow the procedures to remedy the problem.
Observe Work Environment. Note here any risk experience: Observe Work Environment. Note here any risk experience:
provides/replaces bed nets free from holes. Share these with your standing puddles. Share these with your training class.
training class.
Safe: __________________________________________
Safe: __________________________________________ __________________________________________
__________________________________________
At risk: ___________________________________________
At risk: ___________________________________________ ___________________________________________
61 62
JOBS Observation Checklist What do I look for related to
P O I N T
plan observe inform note track management systems?
Risk
Work on
1.1 Window/door screened Work Environment
the job site
and free from holes
Management Systems
it is readily available
Human Behaviors
bed nets with recommended
insecticide/repellent Permethrin Malaria Incident!

free from holes
Filter 1.6 Other areas where insects
could enter are blocked/sealed
Insects can enter a building through any gap that is available to Management systems work together to form a larger whole. For example,
them. Check for gaps around doors, windows, air conditioning our safety management system is part of the Operations Integrity
units or plumbing pipes. If any are found, follow the procedure to Management System (OIMS). Systems like these greatly affect human
report the situation so it can be remedied. By being watchful, you behaviors and work environment.
will help to ensure that no mosquito can enter a building and bite.
Each management system has a specific scope or purpose and common
parts. For example, the scope of our safety management system is, of
course, safety. The parts of each management system are scope and
objectives, procedures, responsible and accountable resources, verification
and measures, and feedback. Think about those parts you observe.
Are any of the parts helping us lower risks? Do any holes or flaws exist
Observe Work Environment. Note here any risk experience: that might lead to a malaria incident?
other areas where insects could enter are blocked/sealed. Share
these with your training class.
Safe: __________________________________________
__________________________________________
At risk: ___________________________________________
Learn to watch for incident causes in management systems.
63 64
2. Management Systems 2. Management Systems
2.1 Awareness and malaria
2.1 Awareness and malaria training on expected critical
Filter training on expected critical safe behavior
safe behavior 2.2 Procedures include
Filter
2.2 Procedures include consideration for malaria hazard
consideration for malaria hazard 2.3 Procurement keeps standard
2.3 Procurement keeps standard list of items stocked
list of items stocked
Avoiding malaria is a team effort. Management systems must take
Awareness and Malaria Training should become an important part into consideration the work and living environments that will be
of the daily operation. It ensures that the people involved are occupied, provide the tools needed to help control the malaria
always up-to-date regarding safe behavior that is critical to hazard, and monitor their application and effectiveness.
everyone’s well being. The training is one of the tools to help
make the environment safer and healthier for everyone concerned.
Observe Management Systems. Note here any risk experience: Observe Management Systems. Note here any risk experience:
awareness and malaria training on expected critical safe procedures include consideration for malaria hazard. Share these
behavior. Share these with your training class. with your training class.
Safe: __________________________________________ Safe: __________________________________________

__________________________________________ __________________________________________
At risk: ___________________________________________ At risk: ___________________________________________

___________________________________________
65 66
2. Management Systems What human behavior should I
2.1 Awareness and malaria
training on expected critical especially look for?
safe behavior
2.2 Procedures include
consideration for malaria hazard Work on
Work Environment
the job site
Filter
2.3 Procurement keeps standard
list of items stocked Management Systems
Management systems must ensure that the supply department Human Behaviors
(procurement) keep standard items stocked and readily available.

These items would include repellent, insecticide, bed nets and
window and door screens. Malaria Incident!
Human behaviors that prevent severe malaria incidents are:
! Chemoprophylactic drug taken

! Treated bed net used
! Insecticide/repellent Permethrin applied to clothes
! Insect repellent applied to exposed skin
! Uses extra precaution (long sleeves, light colored clothing)
! Limits outside activity after dusk
! Reports any malaria-like symptoms
! Being promptly treated for malaria
! Provides information on the HRS form at clinic visit
Observe Management Systems. Note here any risk experience:
procurement keeps standard list of items stocked. Share these
with your training class.
Safe: __________________________________________
__________________________________________
At risk: ___________________________________________
67 68
3. Human Behaviors 3. Human Behaviors
Filter 3.1 Chemoprophylactic drug taken 3.1 Chemoprophylactic drug taken
3.2 Treated bed net used Filter 3.2 Treated bed net used
3.3 Insecticide/repellent 3.3 Insecticide/repellent
Permethrin applied to clothes Permethrin applied to clothes
3.4 Insect repellent applied to 3.4 Insect repellent applied to
exposed skin exposed skin
3.5 Uses extra precaution (long 3.5 Uses extra precaution (long
sleeves, light colored clothing) sleeves, light colored clothing)
3.6 Limits outside activity after dusk 3.6 Limits outside activity after dusk
3.7 Reports any malaria-like symptoms 3.7 Reports any malaria-like symptoms
3.8 Being treated for malaria 3.8 Being treated for malaria
3.9 Provides information on the 3.9 Provides information on the
HRS form at clinic visit HRS form at clinic visit
The most effective weapons against contracting malaria are Treated bed nets are another way to prevent mosquito bites and
chemoprophylactic drugs. Although no drug is without side effects, becoming ill. It is important that bed nets, free from holes, treated with
the risk of contracting malaria usually outweighs them. The kind of the repellent Permethrin always be used even if the room is mosquito-
chemoprophylactic drug prescribed will depend on your medical proof. Permethrin, when applied to fabric, repels and eradicates the
history and the area of the world you are traveling. For the mosquito.
chemoprophylactic drug to be effective, treatment should begin two
weeks before travel, continue during your travel time and continue
for four weeks after returning from your assignment.
If you are having side effects from the drug treatment, please seek
medical help immediately.
Observe Human Behaviors. Note here any risk experience: Observe Human Behaviors. Note here any risk experience:
chemoprophylactic drug taken. Share these with your training treated bed net used. Share these with your training class.
class.
Safe: __________________________________________
Safe: __________________________________________ __________________________________________
__________________________________________
At risk: ___________________________________________
At risk: ___________________________________________ ___________________________________________
69 70
3.1 Chemoprophylactic drug taken 3.1 Chemoprophylactic drug taken
3.2 Treated bed net used 3.2 Treated bed net used
Filter
Filter
3.6 Limits outside activity after dusk 3.6 Limits outside activity after dusk
Using the repellent Permethrin is another step to avoid being bitten Applying insect repellent to exposed skin is another effective way
by mosquitoes. It is a repellent that is only applied to fabric, not to prevent mosquito bites and other disease carrying insect bites.
skin. It can provide protection for weeks and through many Depending on your activities, it will need to be re-applied several
detergent washings. It does not emit fumes or vapors and is very times during the day, as time and perspiration lessen its effect.
safe for humans to use. Check your area to make sure that you have repellent available.
Follow procedures if the supply needs to be replenished.
A thought: Has your outer clothing been recently treated with
Permethrin?
insecticide/repellent Permethrin applied to clothes. Share these insect repellent applied to exposed skin. Share these with your
with your training class. training class.
Safe: __________________________________________ Safe: __________________________________________

__________________________________________ __________________________________________
At risk: ___________________________________________ At risk: ___________________________________________
71 72
Filter
3.6 Limits outside activity after dusk Filter 3.6 Limits outside activity after dusk
Every little bit helps in the fight against being bitten by the mosquito. Peak biting times for mosquitoes are from dusk till dawn. It is best
Wearing long sleeves, long pants, and light colored clothing is another to limit outdoor activities during these hours and stay within well-
defense weapon. Even though you may prefer short pants and a short- screened and protected areas.
sleeved shirt due to the heat, the long pants and sleeves work as another
barrier for the mosquito to fight to bite.
Observe Human Behaviors. Note here any risk experience: uses Observe Human Behaviors. Note here any risk experience:
extra precaution (long sleeves, light colored clothing). Share limits outside activity after dusk. Share these with your training
these with your training class. class.
Safe: __________________________________________ Safe: __________________________________________

__________________________________________ __________________________________________
At risk: ___________________________________________ At risk: ___________________________________________

___________________________________________
73 74
3.6 Limits outside activity after dusk 3.6 Limits outside activity after dusk Filter
Filter 3.7 Reports any malaria-like symptoms 3.7 Reports any malaria-like symptoms
3.8 Being treated for malaria Filter 3.8 Being treated for malaria
It is very important that you seek medical assistance immediately If you have been diagnosed with malaria, it is very important that
for any malaria-like symptoms. you take the prescribed treatment drugs as directed by the physician.
Malaria can be cured with prescription drugs and the length of
Symptoms may include: treatment depends on which kind of malaria is diagnosed, where you
! Fever were infected, your age and how ill you were at the start of the
! Headache treatment. Failure to start and continue treatment can result in severe
! Sweats and chills illness or even death.
! Muscle ache
! Tiredness
! Nausea
! Vomiting
! Diarrhea
! Rapid pulse
! Lightheadedness
! Anxiety
! Mental confusion
reports any malaria-like symptoms. Share these with your being treated for malaria. Share these with your training class.
training class.
Safe: __________________________________________
Safe: __________________________________________ __________________________________________
__________________________________________
At risk: ___________________________________________
At risk: ___________________________________________ ___________________________________________
___________________________________________
75 76
3. Human Behaviors NOTES
3.1 Chemoprophylactic drug taken
3.2 Treated bed net used
3.3 Insecticide/repellent
Permethrin applied to clothes
3.4 Insect repellent applied to
exposed skin
3.5 Uses extra precaution (long
sleeves, light colored clothing)
3.6 Limits outside activity after dusk
3.7 Reports any malaria-like symptoms
3.8 Being treated for malaria
Filter 3.9 Provides information on the
HRS form at clinic visit
When you visit the clinic, does medical fill out the Health Reporting
System (HRS) form? This is important for tracking the performance
of our malaria control program.
Observe Human Behaviors. Note here any risk experience:

provides information on the HRS form at clinic visit. Share these
with your training class.
Safe: __________________________________________
__________________________________________
At risk: ___________________________________________
77 78
That’s all there is to it? How do I inform after observing?
Well, almost. After reading and understanding this book you need to: ! Talk with the person in a non-threatening way.
! practice ! For at risk behaviors, talk with people until they understand why the
act was unsafe.
! practice
! practice ! Ask what work environment or management systems influenced their
behavior. Did an environment or system lower risk? Does an
! practice some more. environment or system need changing?
! Say good things about safe behavior. We want it to happen again!
Take the first step. Plan to do your JOBS. Set goals with your workgroup for how It is important that the people being observed feel you’re there to help them. Use
many you plan to do. Then do them! Encourage others to do them, too. When safe and at risk as a way of talking about what you’ve observed. That’s less likely
you stop to observe, make sure you’re near enough and you can see clearly. A to make people defensive. Ask them their view of the risk compared to yours.
quick glance isn’t enough! You have to stop. Once you’ve practiced doing JOBS, Talk about any differences.
they won’t take long to do.
If you observe at risk environment or behavior, be clear about that when you’re
Practice, practice, practice. Really there is no better way to improve your talking. The other person must have no doubt about what the risk is. Ask people
observation skills. It helps when practicing to first work with an experienced job to explain the risk back to you – to make sure they understand.
observer. It also helps to ask the person being observed for feedback. For
example, say, “I hope that job observation helped you. Now you can help me?” Use the appropriate manuals as guides. Ask people if they’ve had training. A
Then ask something like: question like this isn’t threatening and will help to open up the conversation. The
discussion might also help you find causes in management systems or work
! “Do you have a better understanding of the risks now?” environment. What you learn might help others.
! “Is there anything I can do better with my job observations?”
! “Was I clear?”
Take the first step. Plan to do your JOBS. What you learn might help others.
79 80
When do I note observations? What have been the key points since the last
review?
! Take notes either as you are talking or after you talk.
! To do JOBS: Plan, Observe, Inform, Note and Track.
! Don’t hide your notes from the person you’re observing.
! The JOBS card helps you do job observations in a systematic way.
! Don’t note other people’s names.
! Notes on the JOBS card help us learn what we need to improve.
! Job observations are a very important part of our management systems.
! Malaria incidents can happen. They could happen to you.

Complete the checklist either during or immediately after the observation.
! Learn to watch for malaria incident causes in work environment.
Share your comments. Show the person observed what you’ve written if they want
to see it. ! Learn to watch for malaria incident causes in management systems.
Remember to only note your name – not the name of the person you’re watching. ! Learn to watch for malaria incident causes in human behaviors.
Also remember to give your completed JOBS card to whoever’s assigned to ! Take the first step. Plan to do your JOBS.
collect JOBS data for your site. We’ll use your notes to help us learn and make
things safer for everyone. ! What you learn might help others.
! From JOBS notes we can look for.
1. Plan
2. Observe
3. Inform
4. Note
5. Track
Job OBServations
Take the first step. Plan to do your JOBS.
81 82

GHI Malaria ExxonMobil AppendixA

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GHI Malaria ExxonMobil AppendixA

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ExxonMobil Malaria Control Program

Generic Malaria Control Program

Table 1: Malaria Control Program Execution Plan ..........................................................23

Contractors working in malarious areas on behalf of ExxonMobil, are expected to protect

1.0 Introduction Page 4 of 44

2.0 Procedure for Developing Location Specific Malaria Control Programs

This procedure provides step-by-step guidelines for developing a site-specific malaria

2.1 Implementation tools

The tools include, but are not limited to the following:

Hazard Identification and Risk Assessment

• Malaria Risk Maps

• ExxonMobil Internal Malaria Control Program

• Procedure for Implementing Health Orientation Training

1.1 Introduction Page 5 of 44

• Malaria Case Investigation Form

• Procedure for Implementing a Health Reporting System (HRS)

Implementation Issues (FAQ)

1.1 Introduction Page 6 of 44

2.2 Implementation Steps

Employees who launder their own clothing

4 Develop procedures for the use of A malaria questionnaire must be completed

Upon departure, all expatriate employees and

1.1 Introduction Page 7 of 44

5 Evaluate each facility (e.g., All company-controlled facilities must be

6 Develop procedure for providing General information on malaria prophylaxis is

1.1 Introduction Page 8 of 44

8 Develop procedures for malaria Each location shall be responsible for

Initial training shall be provided to new

Examples of ongoing training may include:

10 Develop procedure to ensure Contractors doing work on ExxonMobil behalf

Clause is included in all new Malaria Prevention Clause:

11 Develop procedures for collecting Examples of verification measures include:

Each site should consider using the

1.1 Introduction Page 10 of 44

ß Number of cases of malaria in non-immune

13 Implement Safety Observation Refer to JOB OBservation Program

1.1 Introduction Page 11 of 44

3.0 Malaria Elements of ExxonMobil Travel Health Program

3.1 Travel Health Program Elements

3.1.1 ExxonMobil Travel Health Clinic

• Travel health consultants must be knowledgeable in malaria prevention and

3.1.2 ExxonMobil Travel Services

Areas of concern include, but are not limited to the following:

1.1 Introduction Page 12 of 44

Internal Malaria Control Program

1.1 Introduction Page 13 of 44

4.0 Malaria Control Program Stewardship

The objective of ExxonMobil MCP are:

The definition of “serious case” is the following:

Malaria cases in non-immune population and serious cases in semi-immune

All cases in non-immune population and serious cases in semi-immune population

4.3 Malaria Chemoprophylaxis Compliance Program (MCCP)

The MCCP objective is to enforce compliance of employees with the approved

1.1 Introduction Page 14 of 44

1.1 Introduction Page 15 of 44

[insert country /location name]

Malaria Control Program

Malaria Control Program Page 16 of 44

Control of malaria infection is achieved through implementation of a management system

A. Awareness and Education measures

Malaria Control Program Page 17 of 44

1.3 Identification of Risks

[Insert other site-specific users]