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REPORT OF MISHAP INSTRUCTIONS For mishaps causing injury or illness to more than one individual, complete and attach a DS1663 (with only sections 119 completed) for each additional individual. 17.

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How to fill out the DoS DS-1663 online

The DoS DS-1663 form is essential for reporting mishaps resulting in injuries, illnesses, or property damage within the context of U.S. Government operations. This guide provides a detailed, step-by-step approach to help users complete the form accurately and efficiently in an online format.

Follow the steps to complete the DoS DS-1663 online effectively.

  1. Click the ‘Get Form’ button to access the DS-1663 form and open it in your selected online editor.
  2. Fill in the agency name for the individual who experienced the mishap in section I, labeled 'Mishap Information.'
  3. In section I, provide the post name for overseas mishaps, or the U.S. city and state for domestic incidents in the 'Post/City, ST' field.
  4. For domestic mishaps, include the organizational symbol of the involved agency in the designated field.
  5. Specify the type of mishap by checking the appropriate boxes in section I.
  6. Enter the date of the mishap in mm-dd-yyyy format in the relevant field.
  7. Indicate the exact time of the mishap using the hh:mm format, ensuring to select either a.m. or p.m.
  8. Check all applicable boxes to describe the location of the event, and provide a brief description of the specific site.
  9. Craft a detailed description of the mishap in section I, explaining the who, what, where, when, why, and how, including any relevant details.
  10. Complete section II by providing the personal details of the injured individual, such as their name, gender, and date of birth.
  11. In section III, report injury or illness specifics, including severity and nature. Make sure to check all applicable boxes.
  12. If applicable, fill in section IV regarding property damage, estimating the damage and detailing the property type.
  13. In section V, outline corrective actions to prevent future mishaps based on findings from the current incident.
  14. Ensure to provide the supervisor/personal supervising officer name and title in section VI, and obtain their signature.
  15. Review all completed sections to ensure accuracy. Once finalized, save the changes, and download or print the form for submission.

Start filling out your DoS DS-1663 online now.

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(3) Class C Accident. An Army accident with resulting total cost of property damage of $50,000 or more but less than $500,000; or an injury and/or occupational illness that results in any lost time from work beyond the day or shift in which it occurred.

A Class B mishap causes permanent partial disability; causes damage valued at between $600,000 and just under $2.5 million; or hospitalizes three people, not counting those admitted for observation or administrative purposes who are treated and released.

CLASS C MISHAP A mishap resulting in one or more of the following: - Direct mishap cost totaling $60,000 or more but less than $600,000. - Any injury or occupational illness that causes loss of one or more days away from work not including the day or shift it occurred.

Aviation Class A Mishaps: The U.S. Air Force defines Class A mishaps as a mishap resulting in direct cost totaling $2 million or more, fatality or permanent total disability, or destruction of a DoD aircraft. Aviation combined unmanned and manned Class A mishaps are on a downward trend.

The report must relate the circumstances of the mishap, names of the individuals involved, any actions taken by the FAA, the number of deaths, or injuries and illnesses, and the extent of injury.

Current Mishap Definitions and Reporting Criteria Mishap ClassTotal Property DamageA$2,500,000 or more and/or aircraft destroyedB$600,000 or more but less than $2,500,000C$60,000 or more but less than $600,000D$25,000 or more but less than $60,0001 more row

There are three basic causes of workplace accidents: chance occurrences, unsafe conditions, and employees' unsafe acts. Chance occurrences (such as walking past a tree just when a branch falls) are more or less beyond management's control.

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