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Ds 11 form printable 2019

Ds1664 form 2026

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The document outlines the procedures and requirements for reporting motor vehicle mishaps involving U.S. Department of State employees overseas. It specifies the need for a DS-1663 form for each individual injured or killed, details on mishap information, driver information, vehicle data, and reporting instructions. The report aims to inform safety officials about serious incidents to prevent future occurrences and is governed by the Occupational Safety and Health Act.

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Click ‘Get Form’ to open the ds1664 in the editor.
Begin by filling out the Mishap Information section. Enter the mishap date in mm-dd-yyyy format and the time in hh:mm, selecting a.m. or p.m. as appropriate.
In the Official Vehicle Driver Information section, provide details such as the driver's agency/organization, name, gender, and last medical screening date. Ensure to include whether seatbelts were worn.
Complete the Official Vehicle Data section by indicating vehicle ownership and type. Include estimated repair costs and a description of any damage.
If there are other drivers involved, fill out their information under Other Drivers and Vehicle Information sections for each additional vehicle.
Utilize the diagram section to sketch how the mishap occurred, labeling vehicles appropriately.
Finally, review all entries for accuracy before submitting your completed form to ensure all necessary details are captured.

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Versions	Form popularity	Fillable & printable
2017	4.8 Satisfied (37 Votes)
2010	4.3 Satisfied (132 Votes)

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Which of the following mishaps must be reported to the safety office?

Reporting is required when mishaps result in personal injury or illness, property damage, or environmental contamination.

What type of mishaps are required to be reported?

Mishap Program Requirements Any civilian with a work-related illness or injury that involves medical treatment beyond first aid, including light duty and/or lost work time is considered a reportable mishap. In addition, off-duty military mishaps or injuries should also be reported.

Which 4 information items are required on a mishap report?

The report must relate the circumstances of the mishap, names of the individuals involved, any actions taken by the FAA, the number of deaths, or injuries and illnesses, and the extent of injury.