COVID-19

Positive Case Reporting Form

The following form is to be completed by an employer/owner when a facility becomes informed of a positive COVID-19 test result for a person who works at, lives at, or attends events at the facility.

• The first set of questions collect business location, type, and the main point of contact.
• The second set of questions collect important COVID-19 information related to the positive case being reported by the employer.
• When reporting multiple cases, please submit individual forms per case.

Completion of this form satisfies the requirement of reporting positive COVID-19 cases to the local health department.