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Reporting Symptoms/Positive Test for COVID-19 Flowchart

January 14, 2022 46055

Flowchart illustrating steps described in Process for Reporting Symptoms/Positive Test Results

Click to view a full-size image

A downloadable version of this flowchart can be accessed at the bottom of this page. 

 

Process for Reporting Symptoms/Positive Test for COVID-19

When symptoms are reported by:

  1. Patient within 2 days following visit – continue to "If Patient Reports Symptoms."
  2. Employee – skip to "If Employee Reports Symptoms."

If Patient Reports Symptoms

  1. Record on Patient Tracking Form:
    • Date of reporting and date patient was last seen
    • Information provided by the patient, including if testing has been done
  2. If there is a positive diagnosis:
    • Assess employee "close contact" exposure.
    • Follow Process for Employee Exposure.
    • Send Notice of Potential Exposure to all workers who were at the worksite during the high-risk exposure period. Notification must be made within one day of learning of positive test, diagnosis, or quarantine. (required as of 1/1/2021)

If Employee Reports Symptoms

  1. Record on Employee Tracking Form:
    • Date of reporting
    • Symptoms
  2. Instruct the employee to return home immediately, if not already home, and to keep the employer updated on status.
  3. Review Cal/OSHA return-to-work requirements.
  4. Determine if there are other employees who should be included in the "exposed group."
  5. Offer employee COVID-19 testing at no cost to them.
  6. If there is a positive diagnosis:
    • Assess if "close contact" exposures occurred at the worksite.
      • If yes, follow the Process for Employee Exposure.
    • If there are three or more infected employees within 14 days, report the outbreak to the local health department.
    • Employers of >5 must report to workers’ comp carrier an employee’s positive COVID-19 test within 3 days.

Process for Employee Exposure

Follow if an employee reports a “close contact” exposure or is determined to have had a “close contact” exposure to a COVID-19 case.

  • Offer all employees with "close contact" exposure COVID-19 testing at no cost to them.
  • Record on Employee Tracking Form details of exposure, including date of exposure.

The employee is boosted, or vaccinated, but not yet booster-eligible:

    The employee does not need to be excluded from the workplace.

Required Actions:

  • Test on day 5.
  • Wear a well-fitting mask around others for 10 days.
  • If testing positive, follow isolation recommendations.
  • If symptoms develop, test and stay home. Review Cal/OSHA return to work requirements with the employee.

An employee is unvaccinated, ** or vaccinated and booster-eligible but has not yet received their booster dose:

Employee May Not Continue to Work

  • Instruct the employee to return home immediately and to keep the employer updated on status. See COVID-19 Prevention Plan for more information.
  • Review Cal/OSHA return-to-work requirements.
  • Determine if there are other employees who should be included in the "exposed group."

**Includes persons previously infected with SARS-CoV-2, including within the last 90 day


Glossary of terms:

  • Close contact – Within 6 feet of a COVID-19 case for a cumulative total of 15 minutes or more over a 24-hour period within or overlapping with the “high-risk exposure period” without respirator worn in accordance with a respiratory protection program.
  • COVID-19 case – A person who has a positive COVID-19 test, has a positive COVID-19 diagnosis from a licensed health care provider or is subject to a COVID-19 related order to isolate issued by a local or state health official.
  • Exposed group – This means all persons in a work location, working area, or a common area at work where a COVID-19 case was present at any time during the high-risk exposure period, without wearing face coverings.
  • Screening and symptoms guidance – Employee Screening Form.
  • Face covering – A surgical mask, a medical procedure mask, a respirator is worn voluntarily, or tightly woven or nonwoven fabric of at least two layers.
  • Fully vaccinated – Means the employer has documented:

(A) A person’s status two weeks after completing primary vaccination with a COVID-19 vaccine with, if applicable, at least the minimum recommended interval between doses in accordance with the approval, authorization, or listing that is:

1. Approved or authorized for emergency use by the FDA;

2. Listed for emergency use by the World Health Organization (WHO); or

3. Administered as part of a clinical trial at a U.S. site

(B) A person’s status two weeks after receiving the second dose of any combination of two doses of a COVID-19 vaccine that is approved or authorized by the FDA, or listed as a two-dose series by the WHO (i.e., a heterologous primary series of such vaccines, receiving doses of different COVID-19 vaccines as part of one primary series). The second dose of the series must not be received earlier than 17 days (21 days with a 4- day grace period) after the first dose

  • High-risk exposure period – COVID-19 cases who develop symptoms from two days before they first develop symptoms until ALL of the following are true: It has been 10 days since symptoms first appeared, 24 hours have passed with no fever without the use of fever-reducing medications and symptoms have improved. For COVID-19 cases who never develop symptoms, from two days before until 10 days after the test specimen was collected.
  • Worksite – Building, store or facility, or other location where a COVID-19 case was present during the high-risk exposure period. It does not apply to buildings, floors, or other locations that a COVID-19 case did not enter, locations where the worker worked by themselves without exposure to other employees, or to a worker’s personal residence or alternative work location chosen by the worker when working remotely
  • Contact tracing – Identifying patients and employees in the office in close contact with the infected or symptomatic patient or employee. Advise the person to seek medical evaluation.
  • COVID-19 test- Means a viral test for SARS-CoV-2 that is now 

(A) Cleared, approved, or authorized, including in an Emergency Use Authorization (EUA), by the United States Food and Drug Administration (FDA) to detect current infection with the SARS-CoV-2 virus (e.g., a viral test);

(B) Administered in accordance with the authorized instructions; and

(C) Not both self-administered and self-read unless observed by the employer or an authorized telehealth proctor. Examples of tests that satisfy this requirement include tests with specimens that are processed by a laboratory (including home or on-site collected specimens which are processed either individually or as pooled specimens), proctored over-the-counter tests, point of care tests, and tests where specimen collection and processing is either done or observed by an employer.

  • Booster-eligible -See CDC Table:  Who Can Get a Booster Shot
  • Up-to-date- Someone who has met all CDC's COVID-19 vaccination recommendations and has obtained their booster.

Required Reporting:

Local health department:

  • Whenever there are three or more employees who test positive or are diagnosed with COVID-19 within 14 days.

Division of Occupational Safety and Health (Cal/OSHA):

  • To report any serious illness or injury or death of an employee that occurred at work or in connection with work.
  • Reporting needs to occur within eight hours of when they knew or should have known of the illness, injury, or death. This includes a COVID-19 illness if it meets the definition of serious illness. “Serious injury or illness” is defined in Title 8 Section 330(h) and includes inpatient hospitalization for a reason other than medical observation or diagnostic testing.

Workers’ compensation carrier:

  • Employers of > 5 employees must notify workers’ comp carrier of an employee with a positive test regardless of where the employee became infected.
  • Have until Oct. 29, 2021, to report employees who tested positive between July 6 and Sept. 17, 2020.
  • From Sept. 18, 2020, until Jan. 1, 2023, report within three business days of learning or reasonable knowing that an employee tested positive for COVID-19.
  • An employee who believes they became ill with COVID-19 due to exposure at work can file a claim and must be given a claim form.

Cal/OSHA Requirements:

  • Employers must make COVID-19 testing available to all employees who are exhibiting COVID-19 symptoms or who had "close contact" exposure to a COVID-19 case at the workplace. The testing must be made available at no cost and during employees’ paid time.
  • Employers may not require a negative COVID-19 test as a condition for an employee returning to work if the employee has satisfied the return-to-work requirements.
  • When an employee is not permitted to work because of a close contact exposure at work, the employer is required to maintain the employee’s earnings and other employee rights and benefits during that time. This may be done by using employer-provided sick leave benefits and other benefit payments from public sources if available.
  • An employee’s earning and other employee rights and benefits also must be maintained during the time they are quarantined if they test positive or are diagnosed with COVID-19 due to exposure at work. An employer must make up the difference for what workers’ compensation does not cover.
  • Refer to a separate chart, “How to Pay Staff During a COVID-19 Related Absence.”

Cal/OSHA Return to Work Requirements:

The period of time before an employee can return to work after “close contact” or COVID-19 illness has been revised to be consistent with current CDPH guidelines. These time frames will automatically update if CDPH updates their guidelines pursuant to the Governor’s executive order.

An employee who was under an order issued by a local or state official to isolate or quarantine may return to work when the order is lifted, 10 days after the order to isolate was effective or 14 days after the order to quarantine was effective.

COVID-19 cases, regardless of vaccination status, previous infection, or lack of symptoms, may return to work when they have met the following criteria:

  • Stay home for at least 5 days.
  • Isolation can end after day 5 if symptoms are not present or are resolving and a diagnostic specimen collected on day 5 or later tests negative.
  • If unable to test or choosing not to test, and symptoms are not present or are resolving, isolation can end after day 10.
  • If fever is present, isolation should be continued until the fever resolves.
  • If symptoms, other than fever, are not resolving continue to isolate until symptoms are resolving or until after day 10.
  • Wear a well-fitting mask around others for a total of 10 days.

Persons who are unvaccinated, or vaccinated and booster-eligible but have not yet received their booster dose who had a close contact exposure may return to work when they have met the following criteria:

**Includes persons previously infected with SARS-CoV-2, including within the last 90 days.

  • Stay home for at least 5 days, after your last contact with a person who has COVID-19.
  • Test on day 5.
  • The quarantine can end after day 5 if symptoms are not present and a diagnostic specimen collected on day 5 or later tests negative.
  • If unable to test or choosing not to test, and symptoms are not present, quarantine can end after day 10.
  • Wear a well-fitting mask around others for a total of 10 days
  • If testing positive, follow isolation recommendations.
  • If symptoms develop, test and stay home.

Persons who are boosted, or vaccinated, but not yet booster-eligible exposed to someone with COVID-19, do not need to quarantine if they:

  • Test on day 5 with a negative result.
  • Wear face coverings around others for 10 days after exposure.
  • If employees test positive, they must follow the isolation recommendations above.
  • If employees develop symptoms, they must be excluded pending the results of a test.

Until further California guidance is released, when an employee who is current on their vaccinations is unable to test on day 5 after close contact, the current ETS guidance applies. As of Jan. 14, 2022, this means employees who are up to date on their vaccinations and cannot be tested on day 5 will need to wear a face-covering and maintain six feet of distance for 14 days following the close contact.

A note on Testing from CDPH:

"Either an antigen test or nucleic acid amplification test (NAAT) can be used. Some people may be beyond the period of expected infectiousness but remain NAAT positive for an extended period. Antigen tests typically have a more rapid turnaround time but are often less sensitive than NAAT.  Antigen testing is preferred for discontinuation of isolation and return-to-work for SARS-CoV-2 infected HCP and for HCP who have recovered from SARS-CoV-2 infection in the prior 90 days; NAAT is also acceptable if done and negative within 48h of return."

Guidance on Quarantine and Isolation for Health Care Personnel (HCP) Exposed to SARS-CoV-2 and Return to Work for HCP with COVID-19

Calculating Quarantine/ Isolation: The date of your close contact exposure, date symptoms started, or the date the positive test was administered is considered day 0. Day 1 is the first full day after your last contact with a person who has had COVID-19.