Texas Christian University
Downloadable Report Forms
General Insurance Questions/Risk
Paul Fox 817.257.7778
and Environmental Management
Randy Cobb 817.257.6363
Jonathan Brown 817.257.7220
Jonathan Roark 817.257.4747
Risk Management Offices
are provided in an Acrobat .pdf format. To obtain the latest version
of Adobe Acrobat Reader, click on the icon above.
Certificate of Insurance
Certificate of Liability Insurance.pdf
- This is an instructional guide
to ensure that a Certificate of Insurance (COI) is properly
completed for vendors and contractors being used on campus.
Insurance for Bus Companies.pdf -
This is an instruction guide to ensure
that a Certificate of Insurance (COI) for use with bus
companies is properly completed.
Vehicle Accident Report
.pdf - TCU's
internal auto accident report form. To be completed by
the driver of the TCU owned, leased or rented vehicle. Complete and return to
the Risk Management office, Box 297110.
Work Injury Report Report.pdf - TCU's internal form
for reporting on the job injuries by faculty, staff or other
employees of the university. Complete and return to
the Risk Management office, Box 297110.
Witness Accident Report.pdf
- TCU's internal
witness form. To be completed by any person witnessing
a personal injury or accident of a visitor, student or staff
member. Return to Risk Management office,
WC Supervisor's Guide.pdf
- TCU's step-by-step guide for
supervisors and department head's concerning the process for
handling workers' compensation injuries.
Student Accident Form.pdf -
TCU's internal form that can be used to report a student
injury or accident, whether the student is employed by the
university or not. Generally, to be completed by the student
involved or the supervisor of the student. Return to Risk
Management office, Box 297110.
Visitor Accident Report.pdf
- TCU's internal form to be used to report an injury or
accident of a visitor on campus.
Care Network Cover Letter
- TCU's internal cover letter introducing the change to
Liberty Mutual's health care network for work related
Employee Notification form
- TCU's guide to using the
Liberty Mutual health care network for work related
- TCU's internal form to be signed by the employee
acknowledging that they received notification of the change
to using LM's health care network.
Worker Survey Form -
Liberty Mutual's survey to be completed by the injured
Certified County Map and Listing
- The county map and listing of counties where the Liberty
Mutual health care plan is effective.
WC TCU Student Employees 'Notice to new
- Form to be signed by student s that informs them that they
have the opportunity to reject workers' compensation
coverage while under employment at the University.
Indoor Air Quality Report.pdf
- TCU's internal form for reporting indoor air quality (IAQ)
problems. To be completed by the individual experiencing IAQ
problems and returned to the Safety Department, Box 297130.
Consent and Assumption of Risk.pdf -
TCU's internal form for informed
consent and assumption of risk for credit course field trips,
internships and practica. This should be retained
in the departmental files for one year. This is a .pdf form. Fill in the blanks,
print and obtain the appropriate signatures.
Consent and Assumption of Risk Instructions.pdf -
Fact sheet that provides information to TCU's internal form
for consent of assumption of risk. This is a .pdf form.
and Voluntary Activities Forms
Student Participant Release &
Indemnity.pdf - TCU's internal for
release and indemnity for student participation in those
activities that are voluntary or do not involve a for-credit
Student Photographic Release form.pdf
- Internal TCU form for the release
and permission to use a student's image in TCU publications.
Vehicle/Fleet related Guidelines and Forms
Rental Insurance Information
Fact Sheet. This form
provides a guide to choosing the proper insurance coverage for
vehicles rented in TCU's name.
of 15-passenger Vans - Provides information
on the TCU policy concerning the use of 15-passenger - and
similar size/style - vehicles.
Off-road Vehicle Insurance Coverage - TCU's
internal reporting form for ensuring that university owned or
leased golf carts, yard trucks and similar vehicles are
properly covered under the university insurance. This is a .pdf form.
Fill in the blanks and print. Forward to the Risk Management
office at Box 297110 or fax to x6677.
ABSO MVR request form
- TCU motor vehicle record request form
that is to be completed and returned to the Risk Management