Need Workers' Comp Help?
Call 831-459-2850

Other Risk & Insurance Help
Call 831-459-5154

Fax 831-459-3268
risk@ucsc.edu

University Business Services
UC Santa Cruz
1156 High Street
Santa Cruz, CA 95064-1077

© UC Santa Cruz

Risk Services Forms

Summary: This page provides a list of Risk Services forms.

Insurance and Special Event Forms

• Request for Certificate of Insurance (MSWord)
• Fine Art Loan Agreement Form (MSWord)
• Fine Art Claim Form (MSWord )
• Liability Loss Report Form (enterable pdf)
• Property Loss Report Form (enterable pdf)
• UCSC Special Event Use Permit (MSWord)
• Special Event Holder Insurance Form (MSWord)
• Theft Buy-Down Insurance Request Form (MSWord)
• Theft Buy-Down Insurance Cancellation Form (MSWord)
• Vehicle Insurance Request Form (MSWord)
• Open Cargo/Foreign Shipments Form (pdf)

Insurance Forms for Use by Purchasing Staff

• NEW! One-Time Insurance Exemption Request (MSWord)
• NEW! Ongoing Insurance Exemption Request (MSWord)

Workers' Compensation Forms

• NEW! UCSC Incident Report Form (pdf)
• Authorization Form for Medical Treatment (pdf)
• Form for Injury or Incident Investigation (pdf)
• Workers' Compensation Form for Volunteers (pdf)
• Transitional Return to Work Form (MSWord)

Waivers

• Required Activites Waiver (pdf)
• Elective/Voluntary Activity Waiver (pdf)
• Facilities Use Athletics Waiver (pdf)
• Facilities Use Other Waiver (pdf)

Foreign Travel

• Request use of a UC Vehicle in Mexico
• Auto Insurance Request for Mexico

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Last revised: May 21, 2008 (am)