By following these steps, you can be sure that the NYS DCJS 3205 form is completed thoroughly and accurately, providing a reliable document for incident management and response.
1. Identifying Information
At the top of the form, write the date and time of the incident. This information sets the timeline for the reported events, so make sure it is precise.
2. Location of the Incident
Specify the exact location where the incident occurred. Include relevant details, such as the facility's room number, building, or area.
3. Details of Individuals Involved
Record the names, addresses, and contact information of all individuals involved in the incident. If applicable, include their roles (e.g., staff, visitor, student) and other identifiers that could assist further inquiries.
4. Incident Description
Provide a detailed description of the incident. This should include what happened, the sequence of events, and any actions the involved parties took. Be as descriptive as possible to give a clear and complete picture of the situation.
5. Witness Information
If there were any witnesses to the incident, list their names and contact information. Include a brief note on their perspective of the incident if it has been shared when filling out the form.
6. Law Enforcement Interaction
Indicate whether law enforcement was contacted regarding the incident. Include details such as the agency involved, the officers' names, and any report or case numbers issued.
7. Follow-Up Actions
Document any immediate actions responding to the incident, such as medical care provided, evacuations, or security measures implemented. Also, note any planned follow-up actions to address the incident’s consequences or to prevent future occurrences.
8. Signature and Verification
The person filling out the form should sign and date it at the bottom, verifying that the information provided is accurate to the best of their knowledge.