Follow the steps to successfully complete the PA STD-430 online.

1. Click the ‘Get Form’ button to retrieve the PA STD-430 and open it in the designated editor.
2. Fill out the first section labeled 'Time and location'. Input the date of the incident or accident, the specific time, and the precise location (including street number, building or institution name, city, county, and state). Indicate whether the time is in the AM or PM.
3. Proceed to the 'Persons injured' section. Enter the names, addresses, and telephone numbers of all individuals involved, along with their ages and the extent of their injuries. If there are more than three individuals, attach an additional sheet if necessary.
4. In the 'Property damage' section, provide details about the owner of the damaged property, including their social security number, address, and telephone number. Estimate the damage and describe both the property and the extent of the damage.
5. Next, give a thorough description of the incident or accident in the appropriate section. This should provide a clear account of what occurred.
6. In the 'Department statement' section, include any relevant statements or notes from the department regarding the incident.
7. Fill in the 'Witnesses' section by listing the names, addresses, and telephone numbers of all witnesses to the event.
8. Complete the 'Claim information' section by providing the name of the employee involved, their working title, address, telephone number, agency, and immediate supervisor's information.
9. Answer the questions in the 'Notification of possible claim' section, indicating how you were notified and whether a claim is being made.
10. Lastly, fill in the 'Reported by' section, providing details about the bureau, agency, and individual preparing the report, along with their contact information.
11. Once all fields are accurately completed, save your changes. You can also download, print, or share the form as needed.

Ready to report an incident? Complete the PA STD-430 online today!