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UW System Home > Offices > Safety & Loss Prevention > Risk Management

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)

Camps and Clinics Forms

• Appendix A HFS 175.03 Lanugage governing the operation of a camp/clinic
• Consent for Medication Administration and Medical Treatment/Health History Questionnaire (revised 1/4/07)
• Reporting Form (view form)
• Premium Calculation Form
• Accident Claim Form (view form)
• Physician's Report (view form )

Property Forms

• Art Exhibit Inventory
• Art Exhibit Protection Memorandum (view form)
• Art Loss Report Form (view form)
• Auto Glass Repair/Replacement
• Borrowed Equipment (view form)
• Business Interruption Schedule (view form)
• Business Interruption Worksheet (view form)
• Farm Property Worksheet (view form)
• Lightning Loss Affidavit
• Property Loss Report (view form)
• Proof of Loss Form (revised 4/06)
• Transportation Log

 

Liabilty Forms

• 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
• Facility Use Agreement without Concessions
• Field Trip Waiver
• General Incident Report Form (DOA 6441)
• Loss Reconciliation Report form (view sample report)
• Notice of Injury Claim Form

 

Others

• Notarized Statement of Driving Record (view form)
• Pilot History Data
• Pilot Questionnaire
• Sales Tax Exemption Form
• Student or Volunteer Driver Authorization Form (view form)
• Vehicle/Equipment Use Agreement Form (view form)
• Vehicle/Equipment Use Authorization Form (view form)
• Vehicle Use Agreement