DSHS Form 03-133 Safety Incident / Close Call Report - Washington

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DSHS Form 03-133 Safety Incident / Close Call Report - Washington

What Is DSHS Form 03-133?

This is a legal form that was released by the Washington State Department of Social and Health Services - a government authority operating within Washington. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is DSHS Form 03-133?A: DSHS Form 03-133 is a Safety Incident/Close Call Report used in Washington.

Q: What is the purpose of DSHS Form 03-133?A: The purpose of DSHS Form 03-133 is to report safety incidents or close calls.

Q: Who is required to fill out DSHS Form 03-133?A: Any individual who witnesses or is involved in a safety incident or close call is required to fill out DSHS Form 03-133.

Q: When should DSHS Form 03-133 be completed?A: DSHS Form 03-133 should be completed as soon as possible after a safety incident or close call occurs.

Q: How should DSHS Form 03-133 be submitted?A: DSHS Form 03-133 should be submitted according to the instructions provided by your employer or the DSHS.

Q: What information is required on DSHS Form 03-133?A: DSHS Form 03-133 requires information such as the date, time, and location of the incident, a description of what happened, and the names and contact information of individuals involved or witnesses.

Q: Why is it important to report safety incidents or close calls using DSHS Form 03-133?A: Reporting safety incidents or close calls using DSHS Form 03-133 helps identify patterns, prevent future incidents, and ensure the safety of individuals involved.

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Form Details:

  • Released on April 1, 2023;
  • The latest edition provided by the Washington State Department of Social and Health Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of DSHS Form 03-133 by clicking the link below or browse more documents and templates provided by the Washington State Department of Social and Health Services.

Download DSHS Form 03-133 Safety Incident / Close Call Report - Washington

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