
Ic swimming pool. It is the responsibility of the pool operator to submit the completed form promptly to the Oregon Department of Human Services, Environmental Services and Consultation, 800 NE Oregon, Portland, OR 97232-2162 Date of Incident Time: am pm Environmental Services and Consultation 800 NE Oregon Street # 21 Portland, Oregon 97232-2162 Phone (971) 673-0451 FAX (971) 673-0457 Accident ID # YYYY – MMDD - County # Official Use Only Victim Information First Name Address MI Num.
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How to use or fill out the OR PHS 100 online
The OR PHS 100 form is essential for reporting incidents, including accidents or drownings, that occur at public swimming pools in Oregon. This guide provides clear, step-by-step instructions on how to complete the form correctly.
Follow the steps to complete the OR PHS 100 online.
- Click ‘Get Form’ button to access the OR PHS 100 form and open it in your preferred document editor.
- Begin by entering the date and time of the incident at the top of the form. Make sure to provide accurate details for official records.
- Fill out the accident identification number, following the format YYYY-MMDD-County #. This helps in categorizing the report.
- In the Victim Information section, provide the first name, middle initial, last name, and address of the victim, along with their age. Indicate if the victim is a non-swimmer and check the applicable type of injury.
- Check the appropriate box under Treatment Required to document the medical assistance the victim received.
- Proceed to the Pool Information section. Input the pool's name, address, contact person, and their position. Indicate whether the pool was open at the time of the incident and if a lifeguard was on duty.
- In the Factors Contributing to the Accident section, check all relevant boxes that apply to the situation. Add any additional details in the space provided.
- If there were other injuries, record their names in the designated area.
- Provide a clear description of the incident in the space provided to ensure a comprehensive understanding.
- Finally, print or type your name, provide your signature, and add the date of completion before submitting the form.
Complete the OR PHS 100 form online today to ensure safety and compliance.
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To apply for the NIH F31 grant, you need to complete an application that includes detailed information about your research and career goals. Follow the specific guidelines provided by NIH and ensure all forms, including the OR PHS 100, are filled out accurately. By being thorough in your application, you enhance your chances of receiving funding and support for your research endeavors.
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