Business Report Form for an Employee who tests positive for COVID-19

If a worker tests positive for COVID-19 in New York State, the employer must immediately notify state and local health departments and cooperate with contact tracing efforts, including notification of potential contacts, such as workers or visitors who had close contact with the individual, while maintaining confidentiality required by state and federal law and regulations.

Please complete and submit the following form for each of your employees that test positive for COVID-19. You may be contacted by an Erie County Department of Health (ECDOH) employee if more information is needed. Thank you for your assistance.

Business Information

Company Address

COVID-19 Positive Case Information

Address