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OSHA Notifications to Public Health

Required fields are marked with asterisks (*)

Employers may contact the local health department immediately for three or more COVID-19 cases over a 14-day period. The County of San Luis Obispo Public Health Department offers guidance on preventing the spread of COVID-19 within the workplace. For more information, read the COVID-19 Prevention Non-Emergency Regulations.

Please complete the form below. You will receive a confirmation it has been submitted.

Employer/Business Name*:
Occupation or Business Type*:
NAICS Code:	North American Industry Classification System Code of Your Workplace How can I determine the correct NAICS code for my business? You can use the search feature at www.census.gov/naics. In the "2017 NAICS Search" box on the left side of that page, enter a keyword that describes your kind of business. Choose the one that most closely corresponds to your primary business activity.
Contact Name*:
Contact Phone Number*:	( ) - Second three digits Last four digits
Business Address*:
Workplace Location:	If different than Business Address
Setting Type Where Covid-Positive Employees Work*:
Number of Covid Cases Within the Past 14 Days*:
Are these Cases Confirmed?*:	Laboratory Confirmed Suspected Unknown
Number of Cases Admitted to a Hospital*:
Number of Cases that have Resulted in Fatality*:
Estimated Total Number of Workers/Persons Exposed?*:
Any Other Information You Would Like to Include: