COVID19 Employer Outbreak Reporting Cover Letter 1-6-21.pdf
COVID19 Non-EDC COVID-19 Pandemic Employee Certification to Return to Work After Being Exposed.pdf
COVID19 Non-EDC COVID-19 Pandemic Employee Certification to Return to Work After Exhibiting Symptoms of COVID.pdf
Reporting Non-Healthcare Facility Outbreaks
Assembly Bill 685 (Chapter 84, Statutes of 2020) requires employers to notify the local Public Health Agency of outbreaks of 3 or more cases of COVID-19 at a worksite within a 14 day period. Assembly Bill 685 applies to all public and private employers in California, except health facilities. Please use this form to report a Worksite Outbreak. Note - “Worksite” means the building, store, facility, agricultural field, or other location where a COVID-19 positive worker worked. This includes hallways, restrooms, lobbies, breakrooms, etc. In accordance with HIPAA Privacy and Security Rules, all information you provide in this form will remain confidential; the information you provide will not impact immigration status.