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)
Camps and Clinics Forms
- Appendix A HFS 175.03 Language governing the operation of a camp/clinic
-
2009 Reporting Form Cover Sheet (view form)
-
2009 Premium Calculation Form
(revised 02/24/2009) -
2010 Reporting Form Cover Sheet (1/8/10)
-
2010 Premium Calculation Form (1/8/10)
-
Accident Claim Form (view form)
-
Physician's Report (view form )
-
2010 Youth Event Health Form (12/10/2009)
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)
-
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) (12/11/09)
-
Request to Add New Facility (owned) (12/11/09)
-
Revised Content Values Request 1/28/10
-
Transportation Log
-
Watercraft Schedule 1/28/10
Liability 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