COVID-19 Employee Report Form
Gwinnett, Newton and Rockdale County employers should report employee COVID-19 infections within their organizations using this form. Please fill this out using weekly intervals (Sunday - Saturday).

𝙄𝙛 𝙮𝙤𝙪 𝙖𝙧𝙚 𝙖𝙣 𝙚𝙢𝙥𝙡𝙤𝙮𝙚𝙧 𝙖𝙩 𝙖 𝙨𝙘𝙝𝙤𝙤𝙡, 𝙙𝙖𝙮𝙘𝙖𝙧𝙚, 𝙡𝙤𝙣𝙜-𝙩𝙚𝙧𝙢 𝙘𝙖𝙧𝙚 ğ™›ğ™–ğ™˜ğ™žğ™¡ğ™žğ™©ğ™®, 𝙧𝙚𝙝𝙖𝙗 ğ™›ğ™–ğ™˜ğ™žğ™¡ğ™žğ™©ğ™® 𝙤𝙧 ğ™Ÿğ™–ğ™žğ™¡, 𝙙𝙤 𝙣𝙤𝙩 𝙪𝙨𝙚 ğ™©ğ™ğ™žğ™¨ 𝙛𝙤𝙧𝙢. Report any positive employees in these settings immediately by dialing 770-339-4260, pressing "0", and asking to speak with the Epi on Call.

*Form should take approximately 2 minutes to complete.*
Sign in to Google to save your progress. Learn more
Email *
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy