Form F 20483 PDF Details

In the state of Wisconsin, the Department of Health Services has established a crucial tool for ensuring the safety and wellbeing of individuals at risk, through the Wisconsin Incident Tracking System (WITS). The F-20483 form serves as a gateway for authorized personnel to gain access to this pivotal system, requiring meticulous completion and submission to uphold the integrity and confidentiality of the data handled within. As part of the process, users must secure a WAMS ID, which is a prerequisite for filling out the form. This involves a series of steps, starting from self-registration on the WAMS homepage to obtaining the necessary supervisory signatures that affirm the user's legitimacy and purpose. The form caters to a broad spectrum of users, including county departments of human services, social services, health, aging units, and even nongovernmental agencies, ensuring that a wide range of professionals working with elder adults-at-risk and adults-at-risk have the tools they need to file reports and manage incidents effectively. With its detailed instructions and requirements, the F-20483 form underscores the state's commitment to safeguarding its citizens through a systematic approach to incident tracking and response, reflecting a blend of technological and human oversight that characterizes modern public health initiatives.

QuestionAnswer
Form NameForm F 20483
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesf20483 wisconsin incident tracking system form

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DEPARTMENT OF HEALTH SERVICES

STATE OF WISCONSIN

Division of Public Health

 

F-20483 (02/2018)

 

WISCONSIN INCIDENT TRACKING SYSTEM (WITS) WEB ACCESS REQUEST

Completion of this form is required in order to have access to the WITS system.

INSTRUCTIONS:

1.Users must first have a WAMS ID, https://on.wisconsin.gov/WAMS/home. Use this URL to logon to WAMS home page and click on self-registration link to create a new account OR use the other options on this page for subsequent account maintenance.

2.Once WITS users have a WAMS ID, they must complete this form, sign the form, have their supervisors sign the form, and then fax the form to DHS, Attn: WITS Security Administrator, Fax – 608-267-3203.

Your Name (Last, First, MI)

Your Phone Number

Date Account Needed

User ID from WAMS

County(ies) for Which You Will be Reporting

Name – Employing Agency (do not abbreviate)

 

 

 

Type of Agency

WITS access needed to file reports on incidents involving:

County Dept. of Human Services, Social Services, Health, etc.

(select one)

County Aging Unit

Elder adults-at-risk only (those age 60+)

Aging and Disability Resource Center

Adults-at-risk only (those age 18-59)

Nongovernmental agency contracted to one of the above

Adults-at-risk in both age groups (18 and over)

Other (describe:

 

 

 

AUTHORIZING SIGNATURES

If your employer is a county agency, county aging unit, or ADRC, complete the following:

Name – Supervisor

Email Address – Supervisor

SIGNATURE – Supervisor

Phone Number - Supervisor

Date Signed

If your employer is a nongovernmental contract agency, complete the following:

Name – County Agency Holding the Contract

Name – County Agency Supervisor or Contract Signer

Email Address – County Supervisor

Phone Number – County Supervisor

SIGNATURE – County Agency Supervisor or Contract Signer

Date Signed

If the WITS user listed above is filling the position of a former employee, complete the following:

Name of Previous Employee

WITS Account Deactivation Date

User of this logon and password provides access to confidential information, which must be safeguarded in accordance with Wisconsin Statutes. The User’s signature on this form constitutes acceptance of responsibility for compliance with Wis. Stat. §§ 49.32(10), 49.32(10m), 49.81, 49.83, and 943.70(2), and with DHS policy (attached to new logon approvals).

SIGNATURE – User

Date Signed

How to Edit Form F 20483 Online for Free

Our top level developers worked hard to obtain the PDF editor we are now proud to deliver to you. The software will allow you to instantly complete Form F 20483 and can save precious time. You just have to comply with this specific guideline.

Step 1: To get started, choose the orange button "Get Form Now".

Step 2: It's now possible to modify your Form F 20483. Our multifunctional toolbar makes it possible to add, delete, adapt, and highlight content material or conduct other commands.

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Form F 20483 spaces to fill in

Complete the SIGNATURE Supervisor, Date Signed, If your employer is a, Name County Agency Holding the, Name County Agency Supervisor or, Phone Number County Supervisor, Email Address County Supervisor, SIGNATURE County Agency, Date Signed, If the WITS user listed above is, Name of Previous Employee, WITS Account Deactivation Date, User of this logon and password, and Date Signed field using the data requested by the software.

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