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COVID-19 Positive Case Reporting Form
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.
Email *
Last Name *
First Name *
Phone Number *
Job Title *
Worksite Location/Department *
Supervisor Name *
Date of Positive COVID19 Test *
Date
First day of symptoms
Date
Last date at work
Date
Location of work on last day at work
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