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 Acrobatpdf format, Adobe Acrobat required 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)

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X

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Art Loan Agreement
(Contract which sets the terms and limitations of insurance coverage for art work loaned to the University)

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X

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

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X

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

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X

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

X

X

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.)

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X

X

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.)

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X

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

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X

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Title Instructions Pdf Word
Field Trip Waiver
This form is currently being revised. Please contact Risk Management at x5079.

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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.)

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X

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Title Instructions Pdf Word
Health History Questionnaire
(Required for all camp/clinic participants under the age of 18 years; used for overnight camps only.)

N/A

X

X
Title Instructions Pdf Word
Insured Packages

(Use to document and insure full value of Univerity owned property in transit.)

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X

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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.)

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X

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

N/A

X

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

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X

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

X

X

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Return Material Instructions

X

N/A

N/A
Return Material Instructions to Return Package (Attachment A)
(Listing of vendors that have certificate of insurance on file with Risk Management. The insurance certificate is only valid until the expiration date given. If insurance information is not available for a vendor, contact Risk Management (x5079) or Purchasing (x4301).)

N/A

X

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

N/A

X

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)

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X

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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.)

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X

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

N/A

X

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

X

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

N/A

X

X
Title Instructions Pdf Word
Waiver of Liability
(Acknowledgement of risks associated with participating in proscribed activities.)
This form is currently being revised. Please contact Risk Management at x5079.

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Please direct any risk management questions to:

Linda Wittmann-Kirsch, Risk Manager
Engelmann Hall, Room 270
Office Phone: 229-5079
Office Fax:    229-6729

or

Kevin L. Glaser
University Safety & Assurances
Engelmann Hall, Room 270
Office Phone: 229-3805

Updated May 15, 2008 by SAK