Claims Management Forms and Information

 

Below is a list of forms and some information sources for Claims Management in the UA system.  If you have come here to fill out a form for an incident or injury, please remember to notify Environmental Health and Safety in addition to any other entity you may be notifying.  If you have any questions regarding the application, purpose, or process of completion of these forms or the notification process, please contact Environmental Health & Safety.

 

Form Name

Blank

Sample

Auto Accident  Report and Claim Form, Claimant's Report

 PDF 

 
Auto Accident Report and Claim Form, UA's Report

PDF

 
Incident Report Form

PDF

PDF

Property Loss Claim Form

PDF

 

Second Injury Fund (Notice of Previous Injury or Illness)

PDF

 
Supervisor's Accident Investigation Report

PDF