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Click ‘Get Form’ to open the doh 5152 in the editor.
Begin by entering the child's name, case number, and date of birth in the designated fields. Ensure accuracy as this information is crucial for identification.
Fill in the agency, client ID number, and disability ID number. This data helps streamline communication with relevant authorities.
Indicate the child's sex by selecting either 'Male' or 'Female'.
Provide details about the worker's name and phone number for follow-up inquiries.
Complete sections regarding school performance, including current grade, class size, and any observed behaviors that may affect eligibility for benefits.
For each behavioral question, select 'Yes' or 'No' and provide examples where applicable. This will assist in evaluating the child’s needs effectively.
Finally, ensure that a teacher or administrator signs and dates the form before submission to validate the information provided.
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To help inform employers and employees, this booklet briefly examines the potential hazards and interventions employers can use to prevent or reduce the
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