IF AN EMPLOYEE HAS BEEN EXPOSED TO COVID AND A POSITIVE TEST PLEASE ANSWER THE FOLLOWING QUESTIONS – Company 1. What was the last date that the employee worked? * 2. What are the employee’s job duties? * 3. Do you have a copy of the test? If so, please advise what date they tested and results. Please provide a copy of the test. * Yes No 4. How many employees tested positive at this job site within 14 days after or before the date the IW tested positive? * 5. What date did each of these employees test positive? * 6. What is the address of the specific jobsite? * 7. What is the highest number of employees that reported to this jobsite within the last 45 days preceding the last day the employee worked? * 8. Do you have a copy of any additional medical reports? * Yes No 9. Do you have any information that would support that this employee contracted Covid-19 outside of work? If so please advise. * Yes No 10. Are you continuing to pay the EE wages? If not, last date paid? * Yes No 11. What is the current work status? * BACK Questions or concerns? Pleasecontact the Safety Department AJ Martinson Safety Specialist OFFICE (714) 796-9110Dial 7 EXT 8118 FAX (714) 276-0129 CELL (657) 341-9804 EMAIL [email protected] Ashley L. Safety Coordinator PHONE (714) 796-9110 EMAIL [email protected]