Get Wi F-62500 2014-2025

The WI F-62500 form is essential for reporting fire incidents in various healthcare facilities in Wisconsin. This guide will walk you through the process of completing the form accurately and efficiently to ensure compliance with the Department of Health Services.

Follow the steps to complete the WI F-62500 form online.

1. Click 'Get Form' button to access the WI F-62500 form and open it in your preferred online editor.
2. Fill in the 'Name – Facility' field with the official name of the facility where the fire occurred. This is crucial for identifying the institution involved in the report.
3. Enter the 'License / Provider Number' associated with the facility to provide necessary identification.
4. Complete the 'Address,' 'City,' and 'Type of Provider' sections, selecting the relevant type from the provided options such as AFH, CBRF, FDD, Hospital, Nursing Home, RCAC, or Other.
5. Input the 'Date of Fire' and 'Time of Fire' in AM/PM format to accurately document when the incident occurred.
6. Describe the type of fire in detail in the 'Type of Fire' section, and use the back of the form for additional information if needed.
7. In the 'Location of Fire in the Facility' field, provide a thorough description of where the fire started to assist in investigation and reporting.
8. Indicate whether anyone was injured and provide the total number injured in the corresponding fields.
9. Specify if the fire alarm system was activated and mark the 'Method of Activation' by indicating manual pull station, heat detector, or others.
10. Answer if a follow-up call was made to the fire department and identify who extinguished the fire in the section provided.
11. Indicate if residents were relocated, if the fire department responded, and if the fire alarm and sprinkler systems were restored to normal condition.
12. Fill in the estimated cost of repairs in the provided field.
13. Complete the 'Name and Title – Person Completing This Report,' 'Telephone Number,' and provide your 'Signature' along with the 'Date Report Completed' to finalize the form.
14. After filling out all necessary fields, you can save changes, download, print, or share the form online as required.

Ensure compliance by filling out the required documents online today.