Follow the steps to successfully complete the form.

1. Press the ‘Get Form’ button to obtain the CA HCAI-OSH-123 and access it in your online editor.
2. In section A, enter the facility identification number. If you do not know it, you may leave it blank. Additionally, fill in the facility name as it appears on the facility license, along with the HCAI project number, street address, city, county, zip code, phone number, and fax number.
3. Still in section A, provide the record name, which is a description of the work to be performed. Ensure that the title matches the one listed in the Application for New Project or Building Permit form.
4. Move to section B and identify the interval or milestone for the report, referring to the approved Testing, Inspection, and Observation (TIO) Program. Enter the last date of construction that this report covers.
5. In section C, specify the elements of construction that were observed. You can either list all work done by the interval or all work related to the specific milestone.
6. Proceed to section D where you must declare compliance based on your knowledge. This is a statement that the work performed complies with approved drawings and specifications.
7. In section E, enter any comments or exceptions related to the observed construction. If needed, you can attach additional sheets to provide further details.
8. In section F, complete the personal details of the individual completing the report. This includes the print name, registration number, firm name, and address.
9. Once you have filled out all sections, save your changes. You may also choose to download, print, or share the completed form for submission.

Complete your CA HCAI-OSH-123 form online today for seamless compliance reporting.