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Due to the frequency of changes to COVID guidelines and updates to these documents, we ask that you bookmark this page and download the documents from this page each time you need to use them rather than saving a local copy to your computer for future use.

Reporting Forms

Interactive Decision Chart

This interactive form is for employees or students who have been exposed to COVID or received a positive COVID test result and need to know what to do next.

Interactive Decision Chart

COVID Reporting Form

Submit the COVID Reporting Form (Appendix C) if you tested positive for COVID-19 and you were on campus within 14 days prior to your positive test collection date.

COVID Reporting Form

Case Response Information for Off-Campus Students

Clinical Interns, Work Experience Students, and CalWORKs Students Who Are Off-Site

Contact Company Nurse (888) 375-9780.

  1. Students who are enrolled in programs where they are authorized to obtain experience off-site whereby contract Los Rios is responsible for the Workers' Compensation coverage including most Clinical Contracts, Work Experience, and CalWORKs placements.
  2. The students covered by our Workers' Compensation have access to Company Nurse to report or obtain advice regarding COVID-19 exposure, symptoms, or positive results.
  3. Company Nurse Report received by VPA will be sent to Coordinator for tracking student.
  4. LRCCD Program Coordinator completes the 5020, Supervisor's Injury Report, and DWC-1 form lines 12, 13 only. Send DWC-1 to students via email or US Postal Service.
    • Return the Forms to the VPA's office or campus work comp designee.
    • The student is not required to complete the DWC-1 form but must receive the form.
    • If the student returns the DWC-1 via email, then send it to VPA's office. Otherwise, they can mail it to District Office at 1919 Spanos Ct. Sacramento CA 95825 Attn: Risk Management.
    • The coordinator must email the VPA if the student has (or has no) classes on campus to evaluate campus exposure to other employees and students within the last 14 days.
  5. If Company Nurse Report was an exposure, then Coordinator will track the student and check in periodically during the next 14 days.
    • If the exposure turns positive, then report to the VPA as that triggers tracking and work comp steps.
    • Follow Clinical site protocols for exposure. For Work Exp/CalWORKs quarantine for 14 days and notify site supervisor. Follow Company Nurse advice or seek advice from a personal doctor.
    • The student will follow guidance by Company Nurse or personal doctor.
    • Since students are not employees, Company Nurse will refer them to their personal doctor as it is an exposure.
  6. If Company Nurse report indicates a Positive test (including asymptomatic), then the Coordinator tracks the student and follows Clinical Site Protocols.
    • If the student is hospitalized or dies, then report to the VPA ASAP.
    • Company Nurse can refer them to Occupational Medicine for treatment or the clinical site may take over treatment.
  7. Coordinator should notify the VPA's office at the end of the 14 days regardless of an exposure or positive outcome to confirm student is back to normal routine and close the case.
  8. Fire Stations and Hospitals: Usually these locations will both provide testing and direct students to next steps. If they do not receive that information, then contact Company Nurse.
  9. If Students are also attending classes on campus, then use COVID Reporting Form (Appendix C).
  10. If site coordinators that are LRCCD employees (working outside the home) are exposed or Positive, then contact campus VPA immediately and call Company Nurse to make a report.