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Business/School Report form for a Positive Employee/Student

If a worker/volunteer tests positive for COVID-19 in New York State, the employer/school must immediately notify state and local health departments and cooperate with contact tracing efforts, including notification of potential contacts, such as workers, students or visitors who had close contact with the individual, while maintaining confidentiality required by state and federal law and regulations.

Please complete and submit the following form for each of your employees/students that test positive for COVID-19. You may be contacted by a Schenectady County Public Health Services employee if more information is needed. Thank you for your assistance.

Organization Name
Organization Address
Your Name
Positive Individual's Name
Positive Individual's Address
Leave blank if not applicable 
Leave blank if not applicable