GUIDANCE AND REGUL ATIONS ®

COVID-19 Exposure Flowchart

PATIENT REPORTS SYMPTOMS EMPLOYEE REPORTS SYMPTOMS
WITHIN 2 DAYS FOLLOWING VISIT OR POSITIVE COVID-19 TEST

RECORD RECORD
On Patient Tracking Form On Employee Tracking Form
• Date of reporting and date patient was last seen • Date of reporting
• Information provided by patient, including if • Symptoms
testing has been done

POSITIVE DIAGNOSIS
• Instruct employee to return home immediately, if not
Assess employee “close contact” already home, and to keep employer updated on status.
exposure; follow process for Review Cal/OSHA return-to-work requirements.
EMPLOYEE EXPOSURE • Determine if there are other employees who should be
included in the “exposed group.”
• Offer employee COVID-19 testing at no cost to them.

NOTICE OF POTENTIAL EXPOSURE POSITIVE DIAGNOSIS

Notify all workers who were at worksite during the high-risk • Assess if “close contact” exposures occurred at the worksite.
exposure period. Notification must be made within one day If yes, follow process for EMPLOYEE EXPOSURE.
of learning of positive test, diagnosis or quarantine, and • If there are three or more infected employees within 14 days,
in the manner the employer normally uses to communicate report outbreak to local health department.
employment-related information. (required as of 1/1/2021) • Employers of >5 must report to workers’ comp carrier an
employee’s positive COVID-19 test within 3 days.

EMPLOYEE REPORTS CLOSE CONTACT EXPOSURE OR IS DETERMINED TO HAVE CLOSE CONTACT EXPOSURE TO COVID-19 CASE

• Offer all employees with “close contact” EMPLOYEES WHO ARE UNVACCINATED,**
EMPLOYEES WHO ARE BOOSTED, OR
exposure COVID-19 testing at no cost to them. OR VACCINATED AND BOOSTER-ELIGIBLE
VACCINATED, BUT NOT YET BOOSTER-ELIGIBLE.
• Record on Employee Tracking Form details of BUT HAVE NOT YET RECEIVED THEIR
exposure, including date of exposure. BOOSTER DOSE.

Employee returns home immediately:

The employee does not need to be excluded from the
workplace. Required Actions: • Keep employer updated on status. See COVID-19
• Test on day 5. Prevention Plan for more information.
• Wear a well-fitting mask around others for 10 days. • Review Cal/OSHA return-to-work requirements.
• If testing positive, follow isolation recommendations. • Determine if there are other employees who should be
• If symptoms develop, test and stay home. Review Cal/OSHA included in “exposed group.”
return to work requirements with employee. **Includes persons previously infected with SARS-CoV-2,
including within the last 90 days

Copyright © 2022 California Dental Association Updated 01/22

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Glossary of terms:
• Booster-eligible – See CDC Table: Who Can Get a Booster Shot.
• Close contact – Within 6 feet of a COVID-19 case for a cumulative total 15 minutes or more over a 24-hour
period within or overlapping with the “high-risk exposure period” without respirator worn in accordance with a
respiratory protection program.
• Contact tracing – Identifying patients and employees in the office in close contact with the infected or
symptomatic patient or employee. Advise person to seek medical evaluation.
• COVID-19 case – A person who has a positive COVID-19 test, has a positive COVID-19 diagnosis from
a licensed health care provider or is subject to a COVID-19 related order to isolate issued by a local or state
health official.
• COVID-19 symptoms --- Means fever of 100.4 degrees Fahrenheit or higher, chills, cough, shortness of breath
or difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion
or runny nose, nausea or vomiting, or diarrhea, unless a licensed health care professional determines the person’s
symptoms were caused by a known condition other than COVID-19.
• COVID-19 test – Means a viral test for SARS-CoV-2 that is now
(A) Cleared, approved, or authorized, including in an Emergency Use Authorization (EUA), by the United States
Food and Drug Administration (FDA) to detect current infection with the SARS-CoV-2 virus (e.g., a viral test);
(B) Administered in accordance with the authorized instructions; and
(C) Not both self-administered and self-read unless observed by the employer or an authorized telehealth proctor.
Examples of tests that satisfy this requirement include tests with specimens that are processed by a laboratory
(including home or on-site collected specimens which are processed either individually or as pooled specimens),
proctored over-the-counter tests, point of care tests, and tests where specimen collection and processing is either
done or observed by an employer.
• Exposed group – Means all employees at a work location, working area, or a common area at work, where
an employee COVID-19 case was present at any time during the high-risk exposure period. A common area at
work includes bathrooms, walkways, hallways, aisles, break or eating areas, and waiting areas. The following
exceptions apply:
(A) For the purpose of determining the exposed group, a place where persons momentarily pass through while
everyone is wearing face coverings, without congregating, is not a work location, working area, or common area
at work.
(B) If the COVID-19 case was part of a distinct group of employees who are not present at the workplace at the
same time as other employees, for instance a work crew or shift that does not overlap with another work crew or
shift, only employees within that distinct group are part of the exposed group.
(C) If the COVID-19 case visited a work location, working area, or common area at work for less than 15 minutes
during the high-risk exposure period, and the COVID-19 case was wearing a face covering during the entire visit,
other people at the work location, working area, or common area are not part of the exposed group.
Note: An exposed group may include the employees of more than one employer.
• Face covering – A surgical mask, a medical procedure mask, a respirator worn voluntarily or a tightly woven or
nonwoven fabric of at least two layers (i.e., fabrics that do not let light pass through when held up to a light source)
that completely covers the nose and mouth and is secured to the head with ties, ear loops, or elastic bands that
go behind the head. If gaiters are worn, they shall have two layers of fabric or be folded to make two layers. A
face covering is a solid piece of material without slits, visible holes, or punctures, and must fit snugly over the nose,
mouth, and chin with no large gaps on the outside of the face. A face covering does not include
a scarf, ski mask, balaclava, bandana, turtleneck, collar, or single layer of fabric.
This definition includes clear face coverings or cloth face coverings with a clear plastic panel that, despite the non-
cloth material allowing light to pass through, otherwise meet this definition and which may be used to facilitate
communication with people who are deaf or hard-of-hearing or others who need to see a speaker’s mouth or facial
expressions to understand speech or sign language respectively.
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• Fully vaccinated – Means the employer has documented:

(A) A person’s status two weeks after completing primary vaccination with a COVID-19 vaccine with, if applicable,
at least the minimum recommended interval between doses in accordance with the approval, authorization, or
listing that is:
1. Approved or authorized for emergency use by the FDA;
2. Listed for emergency use by the World Health Organization (WHO); or
3. Administered as part of a clinical trial at a U.S. site
(B) A person’s status two weeks after receiving the second dose of any combination of two doses of a COVID-19
vaccine that is approved or authorized by the FDA, or listed as a two-dose series by the WHO (i.e., a heterologous
primary series of such vaccines, receiving doses of different COVID-19 vaccines as part of one primary series).
The second dose of the series must not be received earlier than 17 days (21 days with a 4- day grace period) after
the first dose.
• High-risk exposure period – COVID-19 cases who develop symptoms from two days before they first develop
symptoms until ALL of the following are true: It has been 10 days since symptoms first appeared, 24 hours have
passed with no fever without the use of fever-reducing medications and symptoms have improved. For COVID-19
cases who never develop symptoms, from two days before until 10 days after the positive test specimen was
collected.
• Respirator—Means a respiratory protection device approved by the National Institute for Occupational Safety
and Health (NIOSH) to protect the wearer from particulate matter, such as an N95 filtering facepiece respirator.
• Up-to-date – Someone who has met all CDC’s COVID-19 vaccination recommendations and has obtained
their booster.
• Worksite – Building, store or facility or other location where a COVID-19 case was present during the high-risk
exposure period. It does not apply to buildings, floors or other locations that a COVID-19 case did not enter,
locations where the worker worked by themselves without exposure to other employees, or to a worker’s personal
residence or alternative work location chosen by the worker when working remotely.

Required Reporting:
Local health department:
• Whenever there are three or more employees who test positive or are diagnosed with COVID-19 within 14 days.

Division of Occupational Safety and Health (Cal/OSHA):

• To report any serious illness or injury or death of an employee that occurred at work or in connection with work.
• Reporting needs to occur within eight hours of when they knew or should have known of the illness, injury or death.
This includes a COVID-19 illness if it meets the definition of serious illness. “Serious injury or illness” is defined
in Title 8 Section 330(h) and includes inpatient hospitalization for a reason other than medical observation or
diagnostic testing.

Workers’ compensation carrier:

• Employers of > 5 employees must notify workers’ comp carrier of employee with positive test regardless of where
employee became infected.
1. Have until Oct. 29, 2021, to report employees who tested positive between July 6 and Sept. 17, 2020.
2. From Sept. 18, 2020, until Jan. 1, 2023, report within three business days of learning or reasonable knowing
that an employee tested positive for COVID-19.
3. An employee who believes they became ill with COVID-19 due to an exposure at work can file a claim and
must be given a claim form.
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Cal/OSHA Requirements:
• Employers must make COVID-19 testing available to all employees who are exhibiting COVID-19 symptoms or who
had “close contact” exposure to a COVID-19 case at the workplace. The testing must be made available at no cost
and during employees’ paid time.
• Employers may not require a negative COVID-19 test as a condition for an employee returning to work if employee
has satisfied the return-to-work requirements.
• When an employee is not permitted to work because of a close contact exposure at work, the employer is required
to maintain the employee’s earnings and other employee rights and benefits during that time. This may be done by
using employer-provided sick leave benefits and other benefit payments from public sources if available.
• An employee’s earning and other employee rights and benefits also must be maintained during the time they are
quarantined if they test positive or are diagnosed with COVID-19 due to an exposure at work. An employer must
make up the difference for what workers’ compensation does not cover.
• Refer to a separate chart, “How to Pay Staff During a COVID-19 Related Absence.”

Cal/OSHA Return to Work Requirements:

The period of time before an employee can return to work after “close contact” or COVID-19 illness has been revised
to be consistent with current CDPH guidelines. These time frames will automatically update if CDPH updates their
guidelines pursuant to the Governor’s executive order.
An employee who was under an order issued by a local or state official to isolate or quarantine may return to work
when the order is lifted, 10 days after the order to isolate was effective or 14 days after the order to quarantine was
effective. COVID-19 cases, regardless of vaccination status, previous infection, or lack of symptoms, may return to
work when they have met the following criteria:
• Stay home for at least 5 days.
• Isolation can end after day 5 if symptoms are not present or are resolving and a diagnostic specimen collected on
day 5 or later tests negative.
• If unable to test or choosing not to test, and symptoms are not present or are resolving, isolation can end after
day 10.
• If fever is present, isolation should be continued until fever resolves.
• If symptoms, other than fever, are not resolving continue to isolate until symptoms are resolving or until after
day 10.
• Wear a well-fitting mask around others for a total of 10 days.

Persons who are unvaccinated, or vaccinated and booster-eligible but have not yet received their booster dose who
had a close contact exposure may return to work when they have met the following criteria:
**Includes persons previously infected with SARS-CoV-2, including within the last 90 days.
• Stay home for at least 5 days, after your last contact with a person who has COVID-19.
• Test on day 5.
• Quarantine can end after day 5 if symptoms are not present and a diagnostic specimen collected on day 5 or later
tests negative.
• If unable to test or choosing not to test, and symptoms are not present, quarantine can end after day 10.
• Wear a well-fitting mask around others for a total of 10 days
• If testing positive, follow isolation recommendations.
• If symptoms develop, test and stay home.
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Persons who are boosted, or vaccinated, but not yet booster-eligible exposed to someone with COVID-19, do not need
to quarantine if they:
• Test on day 5 with a negative result.
• Wear face coverings around others for 10 days after exposure.
• If employees test positive, they must follow isolation recommendations above.
• If symptoms develop, test and stay home.

A note on Testing from CDPH:

“Either an antigen test or nucleic acid amplification test (NAAT) can be used. Some people may be beyond the period
of expected infectiousness but remain NAAT positive for an extended period. Antigen tests typically have a more rapid
turnaround time but are often less sensitive than NAAT. Antigen testing is preferred for discontinuation of isolation and
return-to-work for SARS-CoV-2 infected HCP and for HCP who have recovered from SARS-CoV-2 infection in the prior
90 days; NAAT is also acceptable if done and negative within 48h of return.”

Guidance on Quarantine and Isolation for Health Care Personnel (HCP) Exposed to SARS-CoV-2 and Return to Work
for HCP with COVID-19

Calculating Quarantine/ Isolation: The date of your close contact exposure, date symptoms started, or date positive
test was administered is considered day 0. Day 1 is the first full day after your last contact with a person who has had
COVID-19.