University Safety and Assurances

Risk Management Forms

This page is intended to provide the UWM campus with commonly used Risk Management forms. From this page, forms can be downloaded in either Microsoft Word or Adobe Acrobat format printed on your local printer, completed and forwarded to the Risk Management Office, Room 270, Engelmann Hall. (Fax number: 414-229-6729)

The following forms are available for immediate downloading:

Title Instructions Pdf Word
Sample Agent Liability Coverage Letter
(Requests that University professional liability coverage be extended to a named individual, performing specific services on behalf of the University)

N/A

pdf format, Adobe Acrobat required

Word Document

Art Loan Agreement  (not owned by UWM)
(Contract which sets the terms and limitations of insurance coverage for art work loaned to the University from another entity.)

N/A

N/A

Word Document

Art Loss Report
(Claim documentation specifically for loss of art works)

N/A

pdf format, Adobe Acrobat required

N/A

Title Instructions Pdf Word
Borrowed Items, Request for Coverage
(Requests coverage for property loaned to the University.)

N/A

pdf format, Adobe Acrobat required

N/A

Camps and Clinics Accident Claim Form
(Completed by the parent or guardian of a camp or clinic participant in case of accident or injury.)

X

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Word Document

Claims Checklist
(NOTE: If you have had a claim, please print this form. The Claims Checklist provides detailed steps to assist with your insurance claim submission.)

N/A

pdf format, Adobe Acrobat required

Word Document

Combined Camps and Clinics Form: Consent for Medication Administration and Medical Treatment / Health History
(Required for all camp/clinic participants under the age of 18 years; used for day camps and overnight camps.)

N/A

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2014 Word Document

2015 Word Document

Title Instructions Pdf Word
Driver Authorization Form
(Establishes agency and driving record status of persons seeking to use state-owned vehicles.)

N/A

pdf format, Adobe Acrobat required

N/A

Title Instructions Pdf Word
Field Trip Waiver

(Acknowledgement of risks associated with participating in proscribed activities.)

See Field Trip Waiver Page

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Title Instructions Pdf Word
General Incident Report
(Documents and describes any type of personal injury or property damage incurred by non-employees.)

N/A

pdf format, Adobe Acrobat required

N/A

Title Instructions Pdf Word
Insured Packages
(Use to document and insure full value of Univerity owned property in transit.)

N/A

pdf format, Adobe Acrobat required

N/A

Title Instructions Pdf Word
Notarized Statement of Driving Record
(A Driver's Authorization Application which indicates a license issued by another state or country MUST be accompanied by this form.)

N/A

pdf format, Adobe Acrobat required

N/A

Title Instructions Pdf Word
Property Loss Report
(Claim documentation for a property loss.)

N/A

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Word Document

Title Instructions Pdf Word
Release of All Claims
(Waiver of claimant's rights to further legal action in exchange for a monetary settlement.)

N/A

pdf format, Adobe Acrobat required

Word Document

Removal of Property and Extended Coverage Request
(Use to document the short term removal of University-owned property.)

X

pdf format, Adobe Acrobat required

N/A

Return Instructions

(Materials being returned to vendors for repair, credit, refund, replacement or exchange must be insured for the full value of the goods. Returns must be processed so that adequate information is provided to Accounts Payable for processing of payments and credits and so that vendor instructions are followed to prevent rejection of the returned goods by the vendor.)

X

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Request for Coverage of Borrowed Items
(Requests coverage for property loaned to the University.)

N/A

click here

N/A

Title Instructions Pdf Word
Special Events Insurance
(A brochure / form designed for Student Organizations and groups using university property for special events.) (Includes Application)

N/A

pdf format, Adobe Acrobat required

N/A

Title Instructions Pdf Word
Union Art Gallery Exhibit/Art Loan Agreement
(Contract which sets the terms and limitations of insurance coverage for art work loaned to the University Union Art Gallery.)

N/A

pdf format, Adobe Acrobat required

N/A

University Owned Artwork Loaning
(Application and agreement for the loan of University-owned artwork.)

N/A

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N/A

Title Instructions Pdf Word
Vehicle Accident/Incident Report
(Form to be completed, signed and submitted to your supervisor within 24 hours of any accident involving a state-owned vehicle.)

N/A

N/A

 

Word Document

Vehicle/Equipment Use Agreement
(Agreement form for loaning UWM vehicles or equipment to authorized agents or agencies)

N/A

pdf format, Adobe Acrobat required

Word Document

Title Instructions Pdf Word
Waiver of Liability
(Acknowledgement of risks associated with participating in proscribed activities.)

See Waiver Page

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Please direct any risk management questions to:


Engelmann Hall, Room 270
Office Phone: 229-5079 or 229-3805
Office Fax: 229-6729