Get Mi Eq1719-a 2020-2025

Filling out the MI EQ1719-A form is essential for reporting incidents related to public swimming pools. This guide provides clear and easy-to-follow steps for completing the form accurately and efficiently online.

Follow the steps to complete the MI EQ1719-A form online.

1. Click ‘Get Form’ button to access the MI EQ1719-A form and open it in your preferred editor.
2. Begin by entering the date of investigation in the designated field. This indicates when the assessment of the incident took place.
3. Fill in the name of the establishment where the accident occurred, followed by the full address, including city or township.
4. Provide the name, title, and contact information of the owner or person in charge of the establishment.
5. Record the name and age of the accident victim. Ensure accurate information is submitted for effective reporting.
6. Indicate the date and time of the accident to establish the timeline of events.
7. Detail the nature of the accident in section 1. Be specific to provide a clear understanding of the incident.
8. Answer whether any injuries occurred. If yes, describe the nature of the injuries and specify if medical attention or hospitalization was required.
9. State what condition or action contributed to the accident, providing detail as needed for clarity.
10. Indicate if any previously cited pool violations may have contributed to the incident. If so, list those violations.
11. Specify if a lifeguard was required and, if so, whether they were present at the time of the accident.
12. If a lifeguard was not required, describe where the nearest responsible person was located and their duties.
13. List any safety equipment that was utilized during the incident.
14. Use the additional comments section to attach any relevant documents or reports that provide further context.
15. Attach a list of names, addresses, and phone numbers of interviewed persons and witnesses to support your report.
16. Ensure to attach a copy of the swimming pool inspection report for reference.
17. Review all entries for accuracy. Once completed, save changes, then download, print, or share the form as needed.

Take the next step in your document management journey by completing the MI EQ1719-A form online.