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# DLA Official Forms

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| Form Number:  DLA1591                                                                                                                                                                                                           |
|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Form Title:  Supervisory Mishap Report                                                                                                                                                                                          |
| Form Version:  Oct 2013                                                                                                                                                                                                         |
| Status:  Active                                                                                                                                                                                                                 |
| Functional Area:  Chief of Staff                                                                                                                                                                                                |
| Opr:  CoS                                                                                                                                                                                                                       |
| Safeguards:  PAS, FOUO, PII                                                                                                                                                                                                     |
| Electronic:  Yes                                                                                                                                                                                                                |
| Form Link:  Documents/FormsSite/forms/DL1591.pdf                                                                                                                                                                                |
| Type:  Primary                                                                                                                                                                                                                  |
| Prescribed:  ESAMS Instruction                                                                                                                                                                                                  |
| Description:  Used by DLA supervisors when access to ESAMS is not available to record the details about and report a mishap. Once access to ESAMS is established the information from this form is transferred into the system. |
| Records Retention:  160.20 Safety and Health Case Files. Disposition. Destroy 5 years after all aspects of the case are closed.                                                                                                 |
| Form Audience:                                                                                                                                                                                                                  |

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