Get the free New FSSA Incident Summary Report Form. 10-10-13 Revised Form 3.5
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FSA Incident Summary Report
for:The State of Indiana
Family and Social Services Administration
Privacy & Security Office
402 W. Washington Street, RM. W353
Indianapolis, IN 46204
H. Cliff McCullough,
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How to fill out new fssa incident summary
How to fill out new fssa incident summary
01
To fill out the new FSSA incident summary, follow these steps:
02
Start by entering the date and time of the incident.
03
Provide a brief description of the incident, including any relevant details such as location or individuals involved.
04
Specify the category of the incident (e.g., medical emergency, property damage, safety violation, etc.).
05
List any witnesses or people affected by the incident, along with their contact information if available.
06
Provide a detailed account of what happened, including the sequence of events leading up to the incident.
07
Include any actions taken immediately following the incident, such as first aid or contacting authorities.
08
Document any additional information or observations that may be relevant to the incident.
09
Double-check all the information for accuracy and completeness before submitting the incident summary.
Who needs new fssa incident summary?
01
Anyone who witnesses or is involved in an incident that falls under the jurisdiction of FSSA may need to fill out the new FSSA incident summary. This may include employees, contractors, clients, or visitors to FSSA facilities.
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What is new fssa incident summary?
The new fssa incident summary is a report that summarizes any incidents that have occurred within the Family and Social Services Administration.
Who is required to file new fssa incident summary?
Certain agencies and organizations are required to file the new fssa incident summary, such as those that provide services to vulnerable populations.
How to fill out new fssa incident summary?
The new fssa incident summary can typically be filled out online or submitted through a designated portal provided by the FSSA.
What is the purpose of new fssa incident summary?
The purpose of the new fssa incident summary is to track and monitor incidents that may impact the safety and well-being of individuals receiving services from the FSSA.
What information must be reported on new fssa incident summary?
Information such as the date, time, location, individuals involved, and a brief description of the incident must be reported on the new fssa incident summary.
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