This page contains the online reporting form to satisfy the reporting requirements mandated for California employers by SB1159. For a downloadable reporting form and additional information and resources related to COVID-19 CLICK HERE.

SB 1159 COVID-19 REPORTING FORM

MWIA Administrator Services, LLC











Note: This is your internal ID number, not a SSN or driver’s license number.

Note: The testing date is the date that a specimen was collected from the employee for testing.)


Please provide the information below for each specific place of employment where the employee worked (meaning the actual address of the building, store, facility, or agricultural field where the employee performed work at employer’s direction) in the 14-day period prior to the testing date. This may be a different location than the business address requested earlier in this form.








To add an additional location, click "add another response"