COVID-19 Positive Case Reporting Form

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This confidential form is for employees to report a positive COVID-19 test result in alignment with OSHA requirements. In accordance with OSHA guidelines, SJCOE is required to maintain records of COVID-19 cases through January 2026. Please complete this form as soon as possible after receiving your positive test results.

E-mail *

Mijn e-mailadres vastleggen bij mijn antwoord

Last Name *

First Name *

Phone Number *

Job Title *

Worksite Location/Department *

Supervisor Name *

Date of Positive COVID19 Test *

JJJJ

First day of symptoms

JJJJ

Last date at work

JJJJ

Location of work on last day at work

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Dit formulier is gemaakt in San Joaquin County Office of Education.

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