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# DLA Official Forms

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Form Information
| Form Number:       | DLA1867                                                                    |
|--------------------|----------------------------------------------------------------------------|
| Form Title:        | Self-Certification Home Safety Checklist                                   |
| Form Version:      | Feb 2003                                                                   |
| Status:            | Active                                                                     |
| Functional Area:   | Human Resources                                                            |
| Opr:               | J1                                                                         |
| Safeguards:        | PII                                                                        |
| Electronic:        | Yes                                                                        |
| Form Link:         | Documents/FormsSite/forms/DL1867.pdf                                       |
| Type:              | Primary                                                                    |
| Prescribed:        | n/a                                                                        |
| Description:       | This form is used to conduct a self-certification home safetey inspection. |
| Records Retention: | coming soon                                                                |
| Form Audience:     |                                                                            |

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