Texas Christian University

Downloadable Report Forms

 

General Insurance Questions/Risk Management Procedures

Claim Information/Reporting

Paul Fox  817.257.7778

Fax: 817.257.6677

 

Safety and Environmental Management

Randy Cobb 817.257.6363

Jonathan Brown 817.257.7220

Fax: 817.257.7744

 

Emergency Preparedness

Jonathan Roark 817.257.4747

 

Risk Management Offices

Email: Riskmgt@tcu.edu

Many forms are provided in an Acrobat .pdf format. To obtain the latest version of Adobe Acrobat Reader, click on the icon above.

Certificate of Insurance Instructions

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.

Certificate of 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.

Accident Forms

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, Box 297110.

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.

Worker's Compensation Forms

Health Care Network Cover Letter - TCU's internal cover letter introducing the change to  Liberty Mutual's health care network for work related injuries.

Employee Notification form - TCU's guide to using the Liberty Mutual health care network for work related injuries.

Employee Acknowledgement form - 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.

Injured Worker Survey Form - Liberty Mutual's survey to be completed by the injured worker.

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 Employees form - 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.

 

Safety/Environmental Forms

  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.

Experiential Learning Forms

Informed 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.

 Informed 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.

Student Participation 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 course.

Photographic Release Forms

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

Car Rental Insurance Information - Fact Sheet. This form provides a guide to choosing the proper insurance coverage for vehicles rented in TCU's name.

Use 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 department.

 

Know What to Do

Risk Management Homepage