Get Incident Report Form - Kansas Department Of Health & Environment - Kdheks

Filling out the Incident Report Form for the Kansas Department of Health & Environment is a crucial step in reporting wastewater incidents. This guide will walk you through each section of the form and provide clear instructions to ensure accurate completion online.

Follow the steps to successfully fill out the Incident Report Form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the facility name and Kansas permit number in the appropriate fields. Make sure this information is accurate as it identifies your facility.
3. Record the date of the incident discovery in the specified field, ensuring you include the correct date format.
4. Indicate the date when the incident ended, if applicable, and any estimated gallons involved in the incident.
5. If the incident is related to rainfall, estimate the approximate inches of rainfall and note the times relevant to the incident.
6. Check all locations that apply under the incident location section, providing specific names, addresses, or manhole numbers as necessary.
7. Select the cause of the incident from the provided list and include any additional explanations if required. If necessary, use an additional page.
8. Outline any corrective actions that were taken to address the incident, making sure to include any further information on an extra page if needed.
9. Finally, complete the contact information for the person submitting the report including name, title, and phone.
10. When you have filled out the form, review for accuracy. You can then choose to save changes, download, print, or share the completed form.

Complete your documentation online today to ensure compliance and swift reporting.