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

Insurance Forms		Workers' Compensation Forms
Request for Certificate of Insurance (MSWord) Fine Art Loan Agreement Form (MSWord) Fine Art Claim 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)		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)
Insurance Forms - Purchasing Use		Waivers
One-Time Insurance Exemption Request (MSWord) Ongoing Insurance Exemption Request (MSWord)		Required Activites Waiver (pdf) Elective/Voluntary Activity Waiver (pdf) Facilities Use Athletics Waiver (pdf) Facilities Use Other Waiver (pdf)
Loss Reporting Forms		Foreign Travel
Automobile Accident or Loss Report Form (enterable pdf) Liability Loss Report Form (enterable pdf) Property Loss Report Form (enterable pdf)		Request use of a UC Vehicle in Mexico Auto Insurance Request for Mexico Travel Insurance Registration - UC Business Travel

Last revised: November 16, 2009 (am)