Outbreak Reporting for Non-Healthcare Business

AB 685 COVID-19 Outbreak Reporting

Please use this form to report an Outbreak of COVID-19 or to report any additional cases from a previous report.

An Outbreak of COVID-19 is considered:

3 or more cases of COVID-19 at a worksite within a 14-day period among employees residing in different households.

Schools will need to report 1 or more cases (Students and/or Staff).

 

The completion of this form is required for all public and private employers of non-healthcare businesses in California.

In accordance with HIPPA Privacy and Security Rules, all information you provide in this form will remain confidential.

Please continue to complete additional forms if new cases need to be reported in the future.

Are the case(s) you are reporting associated with a previously reported outbreak in the past 14 days?

You must have a minimum of 3 COVID-19 cases to report an outbreak.

If you have less than 3 cases to report, it is not considered an outbreak and will not require a report to be submitted.

Business/School Information

Enter the details of the business/school reporting employees with COVID-19.

The North American Industry Classification System (NAICS) code is a standard 6-digit code used to classify a workplace by industry.

To find your business's NAICS code, click here to find your sector number, then search for the specific code for your industry.

Contact Information

Enter the information of the contact person(s) for the business.