DES 3785 at a glance
What it is: DES 3785 is the Compliance Assurance Division Swimming Pool Incident Report of the South Carolina Department of Environmental Services.
Who signs: Owner sign and date the bottom of the form.
Purpose of DES 3785: this form is to be used by public pool owners or operators in the event of a patron death, injury, or accident requiring an EMS response, an emergency room visit, or hospitalization.
A filled-in DES 3785 example: a pool owner reports an incident
How to fill out DES 3785, box by box
I. FACILITY INFORMATION
In the left column of section 1, enter the FACILITY's information including: name of facility, address, city, state, zip, and phone number.
In the right column of section 1, enter the FACILITY's information including: permit number, county, and check the pool type (A, B, C, D, E, F, G).
Select one Pool Type.
II. OWNER INFORMATION
In section 2, enter the FACILITY OWNER's information including: name of facility owner, address, city, state, zip, and phone number.
III. INCIDENT INFORMATION
Circle type of incident (drowning, immersion, cut/abrasion, other). If other, please provide descriptive name.
Select one Type of Incident: A. Drowning, B. Immersion, C. Cut/Abrasion or D. Other.
In the left column enter the date of the incident. In the right column enter the time of the incident.
Check (YES or NO) whether 911, ambulance or emergency room visit was required.
In the left column check the age range of the victim: Child: 0-18, Adult: 18-65 or Senior Citizen: 65+.
In the right column, check the sex of the victim (male or female).
WITNESSES
In the left column enter the names of witnesses to the incident.
DESCRIPTION OF INCIDENT AND ACTION TAKEN
Describe briefly the incident and any actions taken.
Police Report Attached
Check (YES or NO) whether a police report is attached.
SIGN
Owner sign and date the bottom of the form.
Before you go
Please Print or Type Clearly.
Common questions about DES 3785
Where do I file it?
This application must be submitted to the address ATTN: Recreational Waters SCDES 2600 Bull St. Columbia, SC 29201, or faxed to: (803) 898-4215, Attn: Recreational Waters.
Sources
[1] DES 3785 (01/2025), Swimming Pool Incident Report, South Carolina Department of Environmental Services (the Official source link on this page).