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Refer to the INSTRUCTION SHEET. Facility name Facility address number street city Type of Facility HHA ICF SNF OTHER FACILITY TYPE explain Type of Business Entity For EACH business entity identify the name EIN of the entity Corporation Individual LLC Management Company Partnership OTHER Business Entity explain Are any of the above Business Entities a PARENT organization to the applicant facility If Yes explain. Individual s Nature of Involvement Dates of involvement State Zip code Administrator ...

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What is a 215A?

The purpose of the Incident Action Plan Safety Analysis (ICS 215A) is to aid the Safety Officer in completing an operational risk assessment to prioritize hazards, safety, and health issues, and to develop appropriate controls.

What is HS 215A form?

1:48 7:33 Applicant Individual Information Form (HS 215A) - YouTube YouTube Start of suggested clip End of suggested clip Its public record title. In relation to this facility. Enter all titles if you are theMoreIts public record title. In relation to this facility. Enter all titles if you are the administrator. The owner the treasurer etc please enter all titles. Next have you applied for any license.