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Illinois polst form 2019

Form drowning form 2026

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The document outlines the requirements for reporting drownings, injuries, illnesses, or incidents at swimming facilities in Illinois. It mandates that such incidents be reported to the Illinois Department of Public Health within 24 hours and that a detailed report be submitted within seven days. The form includes sections for facility information, incident description, victim details, and supervision at the time of the incident.

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Click ‘Get Form’ to open it in the editor.
Begin by filling out the 'Facility Information' section. Indicate whether your facility is an indoor or outdoor swimming pool, spa, bathing beach, or water slide. Select the type of facility from the provided options and enter the facility name and ID number.
In the 'Description of Incident' section, specify whether it was an illness, injury, fatality, or accident. Provide the victim's name, age, gender, and address. Include a detailed description of the incident including date and time.
Complete the 'Supervision at Time of Accident' section by listing any lifeguards on duty and confirming if the facility was open for swimming during the incident.
Finally, fill out your contact information as the report submitter and ensure all necessary attachments are included before submitting.

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Versions	Form popularity	Fillable & printable
2016	4.8 Satisfied (175 Votes)
2015	4.8 Satisfied (126 Votes)
2014	4.8 Satisfied (160 Votes)
2014	4.1 Satisfied (31 Votes)
2011	5 Satisfied (52 Votes)
2010	4.8 Satisfied (147 Votes)
2009	4.8 Satisfied (116 Votes)
2009	4 Satisfied (20 Votes)
2008	4.8 Satisfied (109 Votes)
2008	4.4 Satisfied (318 Votes)
2002	4.3 Satisfied (231 Votes)
1999	4.5 Satisfied (62 Votes)