Skip survey header

Business / School Positive COVID 19 Report Form

Business / School Positive COVID Case Report Form

The information you provide below is contained on a HIPAA Compliant database and confidentially accessed by the Jackson County Health Department in order to streamline business / school COVID 19 case reporting to the local health department.  State Epidemic Orders require schools to report confirmed and probable COVID-19 cases; businesses are recommended to report so that we can provide assistance in preventing further cases and outbreaks. The survey will take 10-15 minutes to complete and has all of the resources you need to successfully manage the COVID-19 exposure in your specific location (workplace or school). 
The Jackson County Health Department may call you and ask for identifying information, including names and phone numbers, after reviewing your submitted information.
This question requires a valid date format of MM/DD/YYYY.
2. Please provide the following information about the business / school and Point of Contact (PoC) information.  The business PoC should be a manager or human resources contact.  The school PoC should be someone identified as responsible for communicable disease reporting or a school administrator. *This question is required.
4. Please provide the following information for EACH positive COVID-19 case at your business / school.  Select Add Another to add additional people to the list of positive COVID-19 cases for your site. There is no limit.
Is the individual Up to Date on their vaccine series? (Definition: Individual has received both shots of either the Moderna or Pfizer vaccine, or one shot of the J&J vaccine at least 2 weeks prior to exposure, and a booster dose if they are eligible) If Unknown, the Health Department staff can verify in Michigan Care Improvement Registry.
This question requires a valid date format of MM/DD/YYYY.
This question requires a valid date format of MM/DD/YYYY.
  • If positive with no symptoms, monitor for symptoms from day of exposure through day 10 of isolation; and 
  • Isolate at home for 5 days (day “0” is day symptoms begin or day test was taken for students, teachers & staff who do not have symptoms); and 
  • If symptoms have improved or you continue to have no symptoms, return to school, while wearing a well-fitted mask, for days 6 -10; or 
  • Stay home for 10 days if unwilling/unable to wear a mask.
If there is a fever, stay home until fever free for a period of 24 hours without the use of fever-reducing medications. 
A 10 day isolation is appropriate if the individual works with or around others that are immunocompromised (such as an employee of a long-term care or if the individual is an employee that serves vulnerable older adults). 
5. Were Close Contacts Identified?  Definition - Generally, a close contact is defined as an exposure that occurred within 6 feet for 15 minutes or more over a 24 hour period. There are exceptions to this definition that can be found here:
6. Please provide as much information as you can on identified contacts for each close contact.  Select Add Another for each additional contact person.  There is no limit. 
Was Contact Notified of Exposure
Is the Contact Fully vaccinated?  (Reminder:  Fully Vaccinated do not have to quarantine but should monitor for symptoms.  See resource below.)
This question requires a valid date format of MM/DD/YYYY.
Exposure/Quarantine Guidance
  • Close contacts of a COVID-19 case do not need to quarantine at home if they: 
    • Had confirmed COVID-19 within the last 90 days; and/or
    • Are up to date on all recommended COVID-19 vaccines for which they are eligible
These contacts should still monitor their symptoms and “Mask to Stay” for 10 days from the date of last exposure.  
  • Close contacts of a COVID-19 case who do not meet the criteria above need to quarantine or may test to stay and/or mask to stay. Exposed individuals may: 
    • Home quarantine for days 1-5, if feasible test on day 5, AND “Mask to Stay” for days 6-10; or 
    • Test to Stay” for days 1-6 AND “Mask to Stay” for days 1-10 (If a student or school staff); or 
    • Home quarantine for days 1-10 if unable/unwilling to mask 
Individuals should monitor for symptoms throughout quarantine period (days 1 through 10). Day “0” is day of last close contact with any COVID-19 positive individual.  If symptoms develop, get tested and follow isolation guidance.

Employers must quarantine employees with known exposures away from the workplace in accordance with Public Act 339. Additional quarantine guidance can be found here:
Consider these resources if needed to help you understand what you need to do.
For non healthcare work settings
For schools or childcare settings
Cleaning and Disinfecting Instructions:
It is recommended to wait 24 hours since the COVID-19 exposure before cleaning or disinfecting.

Before Cleaning and disinfecting
  • Close off areas used by the person who is sick and do not use those areas until after cleaning and disinfecting.
  • Wait as long as possible (at least several hours) before you clean and disinfect.
  • If less than 24 hours have passed since the person who is sick or diagnosed with COVID-19 has been in the space, clean and disinfect the space.
  • If more than 24 hours have passed since the person who is sick or diagnosed with COVID-19 has been in the space, cleaning is enough.  You may choose to also disinfect depending on certain conditions or everyday practices required by your facility.
  • If more than 3 days have passed since the person who is sick or diagnosed with COVID-19 has been in the space, no additional cleaning (beyond regular cleaning practice) is needed.
7. Could you please check the boxes below the items to indicate which preventive measures have been put into place.