University Safety and Assurances

Claims Checklist

If you have had a loss and need to file a claim, please review this form. The Claims Checklist provides detailed steps to assist with your insurance claim submission.

The Claims Checklist is also available in pdf format for printing: Claims Checklistpdf format, Adobe Acrobat Required

Written (email is acceptable) or verbal notice of loss.

Completed Property Loss Report (if property-related loss). Please contact Risk Management if you have questions about completing this report. Note: This form may be found online on our "Risk Management Forms" page (select “Property Loss Report”).

Completed Vehicle Accident/Incident Report (if vehicle-related loss).
Note: this form may be found online on our "Risk Management Forms" page (select “Vehicle Accident/Incident Report”).

Notify the Police (if theft, property damage, vehicle accident or 3rd party liability claim). We will request a copy of the police report to obtain additional information about your loss.

Original Receipts and other documentation containing detailed information about damaged property items, such as:

  • Make
  • Model
  • Serial Number
  • Purchase Price and Date
  • Place Where Purchased
  • Detailed Description of Item, i.e. “Laptop Computer with 80GB Hard Drive; 512MB RAM; Operating System; 15.4” Wide Screen; 24X CD-RW/DVD; Wireless LAN”

Replacement Receipts or other documentation containing detailed information about replacement property items, similar to “damaged item” information, above [Note: damaged property will be replaced with like kind and quality. We cannot pay for “betterment.” Also, we cannot reimburse for full replacement cost of items until such items have been replaced]. Please discuss with Risk Management prior to replacement if you have questions in this regard.

Purchase Order/External Requisition Number. Note: if a P-card (university-issued purchasing credit card) is used, please forward a copy of your statement.

Voucher Number (if applicable).

Internal Work Order (if applicable).

Detailed breakdown of labor and materials, if applicable. An example is:

  • 5 gallons of white latex paint @ $15.00/gallon = $ 75.00 materials
  • 16.5 hrs of journeyman painter time @ $45.00/hr = $742.50 time

    TOTAL AMOUNT DUE = $817.50

Provide Other Information you feel is important to your claim, or other significant information we request during the claims process.

Complete the Direct Charge of Internal Services Form. Enter your Direct Charge Information, and send or fax one copy of the signed original to University Safety and Assurances and another copy to Pre-Audit