Safety & Loss Prevention
Part 1 General Information
Subject: Forms
Affiliation Agreements:
-
Language for student placement in a clinical/health-care related setting
(view form)
- Caregiver Addendum REQUIRED for student placement in a clinical/health-care related setting (view form)
-
Language for field placement in business/academic setting (view form)
-
Affiliation Agreement Master (5/22/12)
Camps and Clinics Forms
- Appendix A HFS 175.03 Language governing the operation of a camp/clinic
-
2012 Reporting Form Cover Sheet (1/3/12)
-
2013 Reporting Form Cover Sheet (10/10/12)
-
2012 Premium Calculation Form
(1/3/12) -
2013 Premium Calculation Form (10/10/12)
-
Accident Claim Form (3/5/13)
-
2012 Youth Event Health Form (1/3/2012)
-
2013 Youth Event Health Form (10/10/12)
Property Forms
-
Art Exhibit Inventory
-
Art Exhibit Protection Memorandum (view form)
-
Art Loss Report Form (view form)
- Auto Glass Repair/Replacement
-
Borrowed Equipment
-
Farm Property Worksheet 1/28/10
-
FASC Schedule 1/28/10
- Foreign Property Schedule 1/28/10
-
Inventory Valuation Summary Worksheet 2/1/10
-
Lightning Loss Affidavit
-
Musical Instruments Schedule 1/28/10
-
Property Loss Report (view form)
-
Proof of Loss Form (revised 8/09)
-
Request to Add New Facility (leased) 4/30/13
-
Request to Add New Facility (owned) 4/30/13
-
Revised Content Values Request 1/28/10
-
Transportation Log
-
Vehicle Incident Report 2/7/11
-
Watercraft Schedule 1/28/10
Liability Forms
- Agreement for Assumption of Risk, Indemnification, Release, and Consent for Emergency Treatment (waiver) 4/14/10
- Agreement for Assumption of Risk, Indemnification, Release, and Consent for Emergency Treatment (Spanish) 4/12/11
- Agreement for Indemnification, Release, and Consent for Emergency Treatment (shortened waiver) 4/27/10
- Agreement for Indemnification, Release, and Consent for Emergency Treatment (shortened Spanish) 4/12/11
-
Certificate of Coverage to
edit and provide a vendor (view form)
- Certificate of Coverage for
vehicle use (view form)
-
Claim for Damages Against the
State (view form)
- NCAA Master certificate (Hard copy available upon request.)
-
Facility Use Agreement (with concessions) 9/22/11
-
Facility Use Agreement (without
concessions) 9/22/11
-
Field Trip Master Waiver 12/6/2011
-
General Incident Report
Form (DOA 6441)
-
Loss Reconciliation Report form (view sample report)
-
Notice of Claim form 3/7/2012
Others
- Pilot History Data
- Pilot Questionnaire
- Proof of Vehicle Registration/Insurance (2/17/11)
-
Sales Tax Exemption
Form
-
Special Event Questionnaire
-
Telecommuting Form (7/29/10)
-
Vehicle/Equipment Use Agreement
Form (view form)
-
Vehicle/Equipment Use Authorization
Form (view form)
-
Vehicle Use Agreement (2/1/12)
-
Volunteer Letter (9/12/2011)