Get Office Of Risk Management Unit Of Risk Analysis And ... - Doa Louisiana

Filling out the Visitor/Client Post Incident/Accident Analysis form (DA 3000) online is a straightforward process. This guide will provide you with step-by-step instructions on how to complete the form accurately and effectively.

Follow the steps to complete the form online:

1. Click ‘Get Form’ button to access the form and open it in the editor.
2. In the first field, enter the agency name and location code where the incident occurred. Ensure this information is accurate for proper identification.
3. Record the date and time of the accident in the designated fields. This is critical for documentation purposes.
4. Enter the name of the visitor or client involved in the incident. Make sure to spell this correctly for accurate record-keeping.
5. Fill out the address of the visitor or client in the provided section. Include all relevant details to facilitate communication.
6. Provide the claimant’s telephone number so that follow-up can occur if needed.
7. In the next section, describe how the accident occurred. This should be a detailed account to support the incident analysis.
8. Respond to whether the employee asked the claimant about any injuries, selecting ‘Yes’ or ‘No’ as appropriate.
9. Indicate if the claimant reported any injury and specify the part of the body that was stated as injured.
10. Note if medical care was offered and whether the claimant accepted or declined it.
11. Indicate if there were any witnesses to the incident, and provide their names, addresses, and contact information if applicable.
12. Attach any witness statements if available and mark ‘Yes’ or ‘No’ in the relevant field.
13. Detail the location of the accident and check if it is within a state-owned or leased building.
14. If the investigator observed any discrepancies in accounts, note them in the provided section.
15. Choose the applicable environmental conditions at the time of the accident.
16. Select the relevant factors that pertained to the accident, ensuring accuracy in your selection.
17. If any items were involved in the accident, ensure they are tagged and recorded according to the guidelines.
18. Confirm if the claimant was authorized to be in the area where the incident occurred.
19. Document if any employee observed relevant conditions and if a statement was obtained.
20. Submit any photographic evidence attached with the report.
21. Complete the section with the name and position of the employee filling out the report. Remember to date it.
22. Finally, save changes, download, print, or share the completed form as needed.

Start filling out the form online now to ensure accurate documentation of the incident.