Injury Forms

Employee Statement

Injury Report (14 day)

Questionable Claim Notice

 

General Forms 

Risk Management Plan

Self-Inspection for Property (SRM-06)

Unsafe Condition

Aircraft Application

Report of Property/Boiler/Crime Loss (SRM-08)

Certificate of Insurance Request Form  now fillable please return to Suzanne Kubec

Ergonomic Evaluation Request Form  now fillable please return to Sunny Bradford

ErgoPoint Request Form now fillable please return to Sunny Bradford

 

Incident Forms

Department Incident/Accident Reporting Process

Automobile Incident Report (DRM-01)  now fillable please return to Risk Management

Non-Automobile Incident Report (DRM-02)  now fillable please return to Risk Management

New Claim Information  now fillable please return to Risk Management

 

Property Forms

Property/Boiler/Crime Loss Form (SRM-08)   now fillable please return to Nick Witkowski

Property Loss Checklist

Building & Contents Value Definitions

Building & Contents Form  now fillable please return to Nick Witkowski

 

Email comments to:  Risk Management

 

For more information about Risk Management forms, please contact State Risk Management.

 

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