• Confirm with local health jurisdictions who have residents working in the facility which LHD will be responsible for coordinating the outbreak effort (typically the jurisdiction where the facility is located).

• Form an agreement among jurisdictions about how information on new cases will be shared for the investigation and documented in CalREDIE (reported to CDPH). 

• If workers in a facility are unionized, identify an appropriate union contact or worker representative for the LHD and employer. Additionally, clarify the role of the union in the investigation and in communication with workers. If workers in a facility are not unionized, ask the employer to identify a worker representative to serve as a contact for the LHD and employer.

• Confirm the presence of contract or temporary workers in the facility and how communication and instructions will be communicated to these individuals and their employers.

• LHD should request that employers share information (worker roster, positive case reports, etc.) that is vital to understand and control the outbreak and should establish an agreement with the employer about the manner and frequency of providing this information.

• In addition to local laws and ordinances, it is recommended LHDs consider the following authorities when deciding if and how information can be shared between the LHD and employer or between LHDs:

• Health and Safety Code sections 120175, 120175.5, 120185, 120190, 120195, and 120205.
• Health and Safety Code sections 120275 through 120300 address violations of public health laws.
• If applicable (HIPAA-covered entities), Title 45 of the Code of Federal Regulation section 164.512; and
• Title 17 of the California Code of Regulations sections 2500, 2501, and 2505.

• Each workplace is unique and operates under a variety of laws that govern information and protocols to be followed. LHDs should coordinate with their own personnel departments, legal departments, and labor unions (if applicable) to appropriately adjust this general advice to a particular industry.

3. Understand requirements for reporting worker cases to Cal/OSHA.

• Any serious injury, illness, or death occurring in any place of employment or in connection with any employment must be reported by the employer to the local Cal/OSHA district office immediately but not longer than 8 hours after the employer knows. For COVID-19, this includes inpatient hospitalizations and deaths among workers.
• Employers must report serious injury, illness, and death, including hospitalization and death from COVID-19, even if work-relatedness is uncertain.
• Cal/OSHA prefers calls by phone but will also accept email reports (caloshaaccidentreport@tel-us.com). Details on reporting, contact information for district offices, and the Title 8 section 342 requirement are available online.

4.  Identify additional worker cases and close contacts of cases to control further spread in the workplace.

• Testing all workers in a workplace should be the first strategy considered for identification of additional cases. Testing may be done at a single point in time or at repeated intervals.

• LHDs should provide guidance on developing a testing strategy, including how testing can be arranged, and how to prioritize testing of workers. Examples of strategies may include testing close contacts of laboratory-confirmed cases first; prioritizing workers in parts of the workplace with higher case counts; or, if testing capacity is limited, sample pooled testing, also known as "group testing," should be conducted to obtain critical information about the extent of infection with fewer testing resources.
• LHDs may also be able to help facilitate testing options, if needed. Employers should offer on-site COVID-19 testing of workers or otherwise arrange for testing through the company's occupational or general medical services provider. The employer is responsible for ensuring all workers are offered and provided testing. Employers should also provide information to workers who may prefer to contact their personal medical provider or visit a CA Coronavirus Testing Task Force site for testing.

• When testing all workers is not available or not recommended by the LHD, consider alternative methods for controlling the outbreak, including but not limited to tracing all close contacts of confirmed cases and instructing those individuals to quarantine, conducting sample pooling (group testing),  or temporarily closing the workplace and quarantining all workers.
• Conduct contact tracing and quarantining of close contacts of confirmed cases in the workplace.
• LHD should request information from the employer on the confirmed COVID-19 case workers in the workplace, including job titles, work areas, close contacts in the workplace, dates of symptom onset, and shifts worked while infectious.
• Establish if the employer, LHD, or both will conduct interviews of the cases to determine their close contacts.
• Close contacts should be instructed to quarantine at home for 14 days from their last known contact with the worker with COVID-19. Close contacts should be tested for COVID-19 when possible.
• A close contact is someone who spent 15 minutes or more within 6 feet of an individual with COVID-19 infection during their infectious period, which includes, at a minimum, the 48 hours before the individual developed symptoms.
• Interview workers with laboratory-confirmed COVID-19 by phone to determine when their symptoms began, the shifts they worked during their infectious period, and to identify other workers with whom they had close contact during their infectious period.
• Use employment records to verify shifts worked during the infectious period and other workers who may have worked closely with them during that time period.
• While at home, close contacts should self-monitor daily for COVID-19 symptoms (e.g., subjective or measured fever (>100.4°F or 38°C), chills, cough, shortness of breath, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea, vomiting, or diarrhea).

5. Consider whether to temporarily suspend operations due to COVID-19 infection in the workplace.

• Businesses may elect to voluntarily suspend operations when a case of COVID-19, exposure to COVID-19, or an outbreak has occurred in the workplace. This would allow investigation of the exposure and thorough cleaning and disinfection. Businesses may elect to do this if the exposure is in a worker, customer, or visitor of the workplace. Businesses may seek guidance from the LHD if this is an appropriate measure for their workplace.
• The LHD in the jurisdiction where the workplace is located has the authority to close business operations while an exposure is being investigated or an outbreak is being managed.
• Criteria for making a determination for closure may include the size of the workforce, the number or percentage of the workforce impacted, the vulnerability of consumers who visit the business to severe COVID-19 infection, or many other local factors, including the epidemiology of disease spread in the community at large. 
• LHDs may vary in their specific requirements for workplace outbreak investigations, reporting, and suspension of operations.
  
   

6. Notification and instruction to workers.

• LHD should emphasize the need to maintain confidentiality of workers with suspected or confirmed COVID-19 infection when communicating with other workers.

• LHD should instruct the employer to notify all workers who were potentially exposed to the workers with COVID-19. Employers should provide any healthcare consultations needed to advise workers regarding their exposure, which may be especially important for those with high-risk medical conditions (e.g., immune compromise or pregnancy).

• Close contacts of cases should be given instructions on home quarantine, symptom monitoring, and COVID-19 testing. Employers should provide any workers who are sent home before or during a shift with information about what to expect after they are sent home (e.g., instructions about testing, sick leave rights under federal, state, and local laws and company policies, return-to-work requirements, etc.).
• In some outbreaks, but not all, workers who were never symptomatic and did not have close contact with any of the laboratory confirmed cases may continue to work, as long as the employer has implemented all control measures as recommended by public health authorities, Cal/OSHA, or other regulatory bodies. The LHD will make this determination based on strategies being used to control the outbreak and identify new cases (e.g., if mass testing is implemented in the workplace, some workers who were not close contacts to confirmed cases may still be off work while awaiting test results or if the workplace is closed due to the outbreak).

7. Determine when it is appropriate for cases and contacts of cases to return to work.

• Consult most recent CDC guidance for when a confirmed case may be released from home isolation and return to work. This applies both to workers who experienced symptoms of COVID-19 and workers who tested positive for COVID-19 but never had symptoms. The table below is updated per CDC guidance and CDPH Occupational Health Branch recommendations.