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Phone: (818) 677-2079 - Fax: (818) 677-5853 - Mail Drop: 8284

Insurance & Risk Management Forms

Title: Purpose/Use:
Employee Injury, Accident & Investigation Forms:
Supervisor Accident Investigation Guide A reference tool to be used when the supervisor is completing the Supervisor Accident Investigation Report.
Supervisor Accident Investigation Report for Employee Injury To be completed by the supervisor when a university employee is injured.

State Vehicle Accident & Investigation Forms:
Vehicle Accident Report Form (STD 270) To be completed when involved in a motor vehicle accident while on state business.
State Driver Accident Review Form (STD 274) To be completed by the supervisor when a state employee is involved in a motor vehicle accident while on state business.
Authorization to use Privately Owned Vehicle on State business - Employee (STD 261) To be completed annually by all state employees who operate a private vehicle on state business.
Used to report student or campus visitor Non-Motor Vehicle accident or property damage.

Academic Field Trip Forms:
To be completed by all participants before departing on a university sponsored field trip.
Academic Field Trip Participant List Used to record academic field trip participant's emergency contact information.
Air Travel - Attachment G To be completed when a student will be traveling by air on a university sponsored trip.
Authorization to Operate Privately Owned Vehicle - Student To be completed when a student will operate a private vehicle on a university sponsored trip/activity.

Miscellaneous Forms: 
Guest Lecturer/Informed Consent/Hold Harmless Agreement To be completed by guest lecturer prior to lecture.
Independent Contractor Informed Consent/Hold Harmless Agreement To be completed by the independent contractor prior to commencement of service. (Insurance is required).
Volunteer Participation/Informed Consent/Hold Harmless Agreement To be completed when participation in a university sponsored activity is voluntary.
Student Internships To be referenced for student internships in coordination with Purchasing & Contract Administration.
Volunteer Identification Form To be completed when registering a university volunteer. OHRS 20-64 (Office of Human Resources Form).

Please contact the Risk Manager at (818-677-2079) for a quote or additional information.