DS-1963 Safety Checklist – Fillable PDF Form

What Is the DS-1963 Form?

The DS-1963 is the U.S. Department of State’s official safety checklist for teleworkers and alternate duty stations. It is used by agencies to verify that remote work environments meet security and health standards.

How to Fill Out DS-1963 Online

With Formize you can complete the DS-1963 directly in your browser—no need to print, scan, or fax. Follow these simple steps:

1. Click the Fill out this form button on the page.
2. Wait for the Formize PDF Filler app to load (usually a few seconds).
3. Enter the required information in each fillable field. The form automatically saves your progress.
4. When you’re done, click Submit to download the completed PDF or email it to your supervisor.

Common Mistakes to Avoid

• Leaving fields blank: Every question must be answered, even with “N/A” if not applicable.
• Using the wrong date format: Use MM/DD/YYYY as required by the form.
• Skipping the signature line: Both employee and supervisor signatures are mandatory.
• Printing before completing: Save the digital version first; printing early can cause lost data.

Where to Submit the Completed Form

After you finish, the completed DS-1963 can be:

• Uploaded to your agency’s internal portal.
• E‑mailed to your supervisor’s official email address.
• Printed and filed in the physical safety compliance record.

Download the Fillable PDF

If you prefer to work offline, you can download the original fillable PDF from the U.S. Department of State:

Download DS-1963 PDF