Get Az Dcs-1125a 2018-2025

The AZ DCS-1125A form is an Unusual Incident Report designed to document unforeseen events that may impact safety or security within the Arizona Department of Child Safety. This guide will provide step-by-step instructions on how to complete the form effectively and accurately online.

Follow the steps to fill out the AZ DCS-1125A online.

1. Click the ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by selecting the incident types that apply. You can check all relevant boxes including auto-related incidents, injuries, workplace violence, property-related incidents, data/information security issues, and others.
3. Fill in the information about the primary employee involved in the incident. Include their first and last name, region, office address, title, and supervisor.
4. Complete the section regarding the incident itself. Provide the date and time of the incident, a detailed incident description, and specify whether law enforcement was notified along with the agency and police report number, if applicable.
5. List any other involved parties or witnesses. Include their names, phone numbers (with area codes), and roles.
6. If applicable, provide details about any injuries to an employee. Indicate the name of the injured employee, whether medical treatment or hospitalization was needed, and if the incident was fatal.
7. Add the signature of the report writer along with their title and date. The program manager or program administrator should also sign, including their title and date.
8. Review the completed form for accuracy and completeness. Once satisfied, proceed to save your changes. You may also choose to download, print, or share the completed form as needed.

Complete your documents online to ensure proper documentation and compliance.