Report New Coronavirus Cases

  1. This form may be submitted by the individual with suspected or confirmed COVID-19 or by their supervisor or departmental HR on behalf of them.
    • It is not necessary to report full-time telecommuters if they have not been on UCI property.
    • Fields with asterisks (*) are mandatory.
  2. Supervisor Guidance
    • Please ensure that the individual stays at home and seeks medical advice.
    • Do not share the individual’s name with anyone in your department other than HR. The employee’s illness is a confidential medical record in compliance with federal and state regulations.
    • During the pandemic you may ask the individual if they are experiencing symptoms of the pandemic virus.
    • Please consult departmental HR before communicating the incident to other employees in the department.
    • Please review additional instructions that will be provided to you when this form is submitted.

Please complete the following information regarding the person completing this form.