Forms

REPORTS - REQUESTS

NOTIFICATION & INSURANCE FORMS

Accident Reports:

a.) Print form
b.) Fill out completely, Sign and Date
c.) Fax to 805-756-1602 Immediately
d.) Hand deliver original to Risk Management, Building 80 within 1 working day

Vehicle Accident Identification Form STD 269 [pdf]

a.) This form is to be in ALL Vehicles driven on University (State) Business at ALL Times
b.) In the event of an accident, this form contains all of the information to be given to the law enforcement and to the other driver and will help you get the information you need to complete the Vehicle Accident Report. Fill out completely at the site
c.) Detach the information card along the line indicated and give to the “other vehicle driver”

Vehicle Accident Report, STD 270 [pdf]

a.) Fill out on Line
b.) Print out completed form, Sign and Date
c.) Fax to 805-756-1602 IMEDIATELY
d.) Hand deliver original to Risk Management, Building 80 within 1 working day

Supervisor's Report of State Driver Accident STD 274[pdf]

a.) Print Form
b.) Fill out form and Sign and Date
c.) Hand deliver to Risk Management within 5 days

Worker's Compensation Forms

Requests:

Request to Operate Vehicles on University (State) Business [doc]

a.) Fill out Form
b.) Attach a copy of Drivers License
c.) Fill out completely, (if applicable fill out Volunteer form – For information regarding University Volunteers Contact HR)
d.) Have Supervisor Sign and Date
e.) Hand deliver all to Risk Management, Building 80 within 48 hours.

Authorization to Use Privately owned Vehicles on State Business STD 261

a.) Print out form and Complete
b.) Have Supervisor Sign and Date, Annually
c.) Department Office Retains Form

Volunteers

Vehicle Home Storage Request/Permit

Mobile Equipment/Vehicle Insurance Request Form

a.) Please fill out the request and email to jrisser@calpoly.edu - (only way to submit the form)
b.) I will email a quote back to the requestor.
c.) Upon Acceptance of the insurance quote, I will then charge the chartfield provided on the request.

Special Event Insurance

University Sponsored Special Event Insurance Request [doc]

a.) Online fill in form
b.) Fill out completely
c.) Save to your local drive and then attach the completed form to an email to: jrisser@calpoly.edu
d.) Email a minimum of 3 weeks BEFORE the Event

Field Activities Forms

Field Activities Notification Form

University Activity Release Agreement

Foreign Travel Insurance Applications

Foreign Travel Insurance Program