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.
•	Accident Report Form-Non Motor-Vehicle Form (Student, Visitor, Non-Motor Vehicle) (STD 268)	Used to report student or campus visitor Non-Motor Vehicle accident or property damage.

Academic Field Trip Forms:
•	Academic Field Trip Informed Consent Agreement	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.