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COVID-19 Residential Care Facility Reporting Form

Please use this COVID-19 Residential Care Report Form to report any COVID-19 positive employees and/or residents to the Livingston County Health Department.

Residential Care facilities are required by the MDHHS Epidemic Order to report all cases of COVID-19 within the facility to the Local Health Department within 24 hours of notification. 

Questions can be directed to:
Linda Weiman | Public Health Nurse Supervisor | 517-552-6809 | lweiman@livgov.com
Emma Harman | Epidemiologist | 517-552-6836 | eharman@livgov.com

 
Provide the following information about the Residential Care Facility: *This question is required.
Upload a COVID-19 Building Schematic, indicating COVID+ resident rooms. This can also be faxed to the LCHD secure fax at : 517-545-9685. 
Are you reporting an EMPLOYEE or RESIDENT? *This question is required.

If you are reporting both EMPLOYEES and RESIDENTS, please select "EMPLOYEE"