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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.  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.
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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 Fully Vaccinated? (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.) If Unknown, the Health Department staff can verify in Michigan Care Improvement Registry.
This question requires a valid date format of MM/DD/YYYY.
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This question requires a valid date format of MM/DD/YYYY.
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Each positive individual needs to isolate for 10 days since their start of symptoms or 10 days since they tested positive if they are asymptomatic.
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: https://www.cdc.gov/coronavirus/2019-ncov/php/contact-tracing/contact-tracing-plan/appendix.html
 
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.
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We recommend individuals quarantine away from the school/workplace and others for at least 10 days since their exposure. Employers must quarantine employees with known exposures away from the workplace in accordance with Public Act 339. Additional quarantine guidance can be found here: https://www.cdc.gov/coronavirus/2019-ncov/your-health/quarantine-isolation.html
Consider these resources if needed to help you understand what you need to do.
For non healthcare work settings
https://www.cdc.gov/coronavirus/2019-ncov/community/contact-tracing-nonhealthcare-workplaces.html
For schools or childcare settings
https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/contact-tracing.html
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.