COVID-19 Positive Test Report
Please complete one report for each positive COVID-19 test on form below. If you’d prefer to download the form and submit via email or fax, click here.
This report does not generate a claim or qualify as a reported claim. To submit a claim, please go to www.acmclaims.com or call (866)671-5042.
Per California Labor Code Section 3212.88 – If you are aware of an employee testing positive for COVID-19 on or after July 6, 2020, you must report it to your claims administrator.
- Positive COVID-19 test results on July 6, 2020 through September 17,2020 must be reported to your claims administrator by October 30, 2020.
- Positive COVID-19 test results after September 17, 2020 require reporting within 3 business days of knowledge (or when it should reasonably have been known).
FAILURE TO REPORT COULD RESULT IN CIVIL FINES UP TO $10,000.