info@iowa.gov
200 E Grand, Des Moines , IA, 50309, US
The operator shall immediately report by phone a fatality or an accident that requires medical care more than first aid. An operator shall report in writing to the Labor Commissioner an accident resulting in injury within 48 hours after occurrence of the incident. The report of an accident shall include this completed form and a copy of the report submitted to insurance companies. The Labor Commissioner may require that the scene of an accident be secured and not disturbed more than necessary for removal of deceased or injured persons. If covered equipment is removed from service by the Labor Commissioner, the Labor Commissioner shall order an immediate investigation and the covered equipment shall be released for repair and operation only after a complete investigation.
The covered equipment may not be returned to service until it successfully passed a complete inspection.
Use this form to report a boiler or pressure vessel explosion.File this form if a boiler or pressure vessel explodes or a malfunction causes an acute illness or injury that needs professional medical care, or a disability that lasts more than one day. Report by calling 515-669-8945 or 515-725-2050. An incident that occurs during DIAL office hours must be reported by close of business on the day of the incident. An incident that occurs when DIAL is closed must be reported by close of business on the next DIAL business day.Removal of damaged parts or use of the object is prohibited by Iowa Administrative Code.
The owner shall promptly notify the Labor Commissioner if a personal injury accident requires the service of a physician; if a personal injury accident causes disability exceeding one day; or, if a conveyance suffers damage that will require more than one hour of a mechanic's time (excluding travel) to repair. Notification shall be in writing and shall include the state identification number, owner, and description of the accident. If a report is required and any part of the conveyance or its operating mechanism has failed or been destroyed, the use of the conveyance is forbidden until it has been inspected and approved by the Labor Commissioner. The removal of any part of the damaged conveyance or operating mechanism from the premises is forbidden until permission has been granted by the Labor Commissioner.
Is the operator's address different than the business' address?
Date and Time of Accident
Do you have videotape and/or photographs of the incident?
Were safety orders issued at the last inspection?
Date of Last Inspection (click twice on the month and year at top of calendar to change year)
Does the operator have a permit to operate?
Does the boiler or pressure vessel have an operating certificate?
Are repairs needed now?
Has the equipment been secured from operation?
Has the operator been notified?
Has the conveyance contractor been notified?
Have the local authorities been notified?
Upload Attachment(s) - reports, photos, etc.