COVID-19 Positive Case

Reporting Form

To comply with subsection 3205U of the Cal-OSHA COVID-19 prevention regulations, please complete the following fields.

 

First and Last Name

 
 
 
 
 

For employees, please enter the work location, including office, dept. or facility


For students, please enter classrooms or facility

 

Please enter the last date you were physically present at CPP prior to the positive test/diagnosis

 
mm/dd/yyyy
 

Please enter the date you tested positive for COVID-19 (antigen testing) or received a formal diagnosis

 
mm/dd/yyyy