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How do I fill this out?
To fill out this report, gather necessary employee information and test result details. Ensure that the report is submitted to the designated email or fax. Follow the internal reporting procedures for claims submission.
How to fill out the COVID-19 Positive Test Report Submission?
1
Gather employee details including name and contact information.
2
Record the date of the positive COVID-19 test.
3
Indicate if the case is reported as industrial.
4
List locations where the employee worked in the 14 days prior.
5
Submit the completed report to the provided email or fax number.
Who needs the COVID-19 Positive Test Report Submission?
1
Employers needing to report COVID-19 cases for compliance with labor laws.
2
Human Resource departments who manage employee health reports.
3
Occupational Safety and Health Administrators ensuring workplace safety.
4
Claims Administrators processing workers' compensation claims.
5
Employees who must report their positive test results to employers.
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What are the important dates for this form in 2024 and 2025?
Important dates for submission include: Testing results from July 6, 2020 to September 17, 2020 must be reported by October 29, 2020. Positive COVID-19 test results after September 17, 2020 require reporting within 3 business days of knowledge.
What is the purpose of this form?
The purpose of this form is to formally report an employee's positive COVID-19 test to the relevant claims administrator. This ensures compliance with California Labor Code Section 3212.88, which mandates reporting of such cases. It is essential for tracking the impact of COVID-19 in the workplace and facilitating appropriate responses by the employer.
Tell me about this form and its components and fields line-by-line.
- 1. Employer Name: The name of the organization submitting the report.
- 2. Number of Employees: Total number of employees in the organization.
- 3. Date of Positive Test: Sample collection date of the positive COVID-19 test.
- 4. Contact Information: Includes phone number and email of the primary contact for follow-ups.
- 5. Work Locations: Addresses where the employee worked in the 14 days before the test.
What happens if I fail to submit this form?
Failing to submit this report can lead to legal and financial repercussions for the employer. Companies could face penalties under labor laws and risk employee safety issues going unaddressed. It is crucial to submit this form in a timely manner.
- Legal Ramifications: Non-compliance with labor laws can result in fines and legal action.
- Employee Safety: Failure to report may hinder effective contact tracing and workplace safety measures.
- Financial Risks: Potential workers' compensation claims may be negatively impacted.
How do I know when to use this form?
- 1. Employee Reporting: To document positive COVID-19 test results by employees.
- 2. Employer Compliance: Employers use this to meet their legal obligations.
- 3. Claims Processing: Necessary for claims administrators to process cases correctly.
Frequently Asked Questions
How do I submit the COVID-19 report?
You can submit the report by emailing it to COVIDREPORTING@Aims4Claims.com and cc: jbwcp@jud.ca.gov, or by faxing it to (916) 563-1919.
What details are required in the report?
Required details include employee name, test result date, work locations, and confirmation of whether the report is industrial.
Can I edit the PDF on PrintFriendly?
Yes, PrintFriendly offers editing tools that allow you to modify the PDF before downloading.
What type of test results need to be reported?
Only Polymerase Chain Reaction (PCR) test results or other viral testing results approved by the FDA should be reported.
Is there a deadline for reporting positive test results?
Yes, positive tests must be reported within specific timelines as indicated in the reporting guidelines.
How do I share the PDF with others?
You can share the PDF via email or create a link directly from PrintFriendly.
What is the purpose of this report?
The report is used to notify the claims administrator of an employee's positive COVID-19 test for compliance with labor laws.
Can I sign the PDF using PrintFriendly?
Yes, you can digitally sign your PDF using the signature feature available on PrintFriendly.
What if I make a mistake in the report?
You can edit the report on PrintFriendly before downloading it to ensure all information is correct.
What happens if I fail to submit this report?
Failing to submit this report may hinder effective contact tracing and workplace safety measures.
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