, or incidents requiring hospitalization to be reported to the Department within 24 hours. In addition, this form must be completed and returned to the office that serves your facility within seven days of the incident. A separate report shall be completed for each victim. In the event of a drowning, the Department’s Springfield Office should be advised immediately at 217-782-5830. After work hours, drownings may be reported to the Illinois Emergency Management Agency at 1-800-782-7860. This f.
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How to fill out the IL IL 482-0821 online
The IL IL 482-0821 is an important document required by the Illinois Department of Public Health to report any incidents related to drowning, injuries, illnesses, or accidents occurring at swimming facilities. This guide provides step-by-step instructions to help you successfully complete the form online.
Follow the steps to complete the IL IL 482-0821 online.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Begin by filling in the facility information section. Indicate the type of facility (e.g., indoor or outdoor swimming pool, spa, bathing beach, etc.) and provide the name of the facility along with its ID number, street address, city, and county.
- In the description of the incident section, select the appropriate category of the incident (illness, injury, fatality, or accident). Record the name and age of the victim, their address, and telephone number, and specify their gender.
- Provide detailed information about the incident, including the date, time, and circumstances. You may attach additional sheets if necessary, along with any available police reports.
- In the supervision section, list the names of all lifeguards on duty at the time of the incident and attach a copy of their current certification. Indicate whether the facility was open for swimming at the time of the incident.
- Record the name and address of the medical facility that provided treatment or diagnosis. Include the city of the medical facility as well.
- Complete the contact information for the person providing further information about the incident. This should include their name, title, and telephone number.
- Enter the name and contact details of the person who completed and submitted the report, including their title.
- Review the completed form to ensure that all required fields are filled correctly. Then, save changes, download, print, or share the form as needed.
Ensure you complete and submit your form online to comply with the reporting requirements promptly.
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