Business/School Report Form for an Employee/Student/Volunteer who tests positive for COVID-19

If a worker/volunteer/student tests positive for COVID-19 in New York State, the employer/school must immediately notify state and local health departments and cooperate with contact tracing efforts, including notification of potential contacts, such as workers, students 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/students 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/School Information

Business/School Address

COVID-19 Positive Case Information

Address