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For Office Use OnlyARKANSAS DEPARTMENT OF HEALTH Vital Records. Supplemental Report of course of Death Page Year Name of Deceased Date of DeathCounty of DeathSexRaceI hereby certify that the cause
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The supplemental report of cause is a document that provides additional information about the causes of an incident or accident.
Individuals or organizations involved in an incident or accident are required to file a supplemental report of cause.
The supplemental report of cause should be filled out with detailed information about the incident, including causes and contributing factors.
The purpose of the supplemental report of cause is to help determine the root causes of an incident and prevent similar incidents in the future.
Information such as the date and time of the incident, the location, individuals involved, and a detailed description of what happened must be reported on the supplemental report of cause.
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