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Reporting Accidents (Vehicle/Student/Visitor/Contractor) and Property Loss

Instructions for Reporting Accidents

 

Provide Initial Report within 24 hours of the incident

(Click Here for Employee Accident, Injury or Near Miss)

 

 
Information on This Page
Associated Form
 
       
   
       
 

Automobile Accident Procedure Reporting Form

09/01/13 to 08/31/14 Accident

 
       
   
       
 

Special Risk Accident and Sickness Claim Form

03/01/13 to 03/01/14 Accident

 

When an accident involving a student, visitor or vehicle has occurred, or when there has been a property loss, it is important to gather all information associated with the incident and forward it to the University of Houston System Risk Management representative on a timely basis. All initial information should be supplied to:

University of Houston-Downtown

Risk Management and Compliance

One Main Building, Room 621 S

Houston, TX 77002-1001

Phone: 713-222-5340

Fax: 713-226-5546

Contact: Mary Cook

Supplying the information on a prompt basis is critical to an investigation and allows prompt steps to be taken to identify problems, take corrective measures to mitigate future risks and make assessments for any needed insurance or legal actions.

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Student/Visitor/Contractor Accident/Injury

 

 

Form Required:

Student/Visitor/Contractor Accident Report Form

 
 

Timing for Form:

Report to UHD Risk Management for forwarding to UH Risk Management within 24 hours of the incident.

 
 

Timing for Additional Information:

As the information becomes available, also include all available witness statements, official reports or records, photos, videos and any additional information that will assist in the accident investigation.

 
 

Report Needed If:

Any student or visitor injury that could result in a potential claim against UHD

 
 

Who is Responsible for the Additional Report(s)/Information?

  • Initial Form- Individual involved in the accident/incident. If individual unable to complete the form initially, UHD employee should provide an  initial  report/assessment of the accident/incident via e-mail/Police report.
  • Photos – Environmental Health and Safety
  • Video - Electronic Security Systems Manager
  • Follow Up Reports/Records – Department receiving the reports/information
 
 

Policy Reference:

SAM 01.C.09 - Risk Management - Tort Liability

 

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Vehicle Accidents

 

 

Initial Form Required:

Automobile Accident Procedure Reporting Form

09/01/13 to 08/31/14 Accident

 
 

Timing for Form:

Report to UHD Risk Management for forwarding to UH Risk Management within 24 hours of the incident.

 
 

Timing for Additional Information:

As the information becomes available, also include the police report, any official reports or records, photos, videos and any additional information that will assist in the accident investigation.

 
 

Report Needed If:

There is a vehicle accident, whether the vehicle was damaged or not

 
 

Who is Responsible for the Additional Report(s)/Information?

  • Initial Form - The employee involved in the report.  If no employees involved, the Officer responding to the call/incident
  • Photos – Environmental Health and Safety
  • Video - Electronic Security Systems Manager
  • Follow Up Reports/Records – Department receiving the reports/information
 
 

Deductible:

  • First $500 for collision or comprehensive claims
  • Department pays deductible on any funds paid for resulting claims
 
 

Policy Reference:

SAM 01.C.02 - Risk Management - Allocation of Insurance Premium and Claim Reimbursement

  and

SAM 01.C.13 - Risk Management - Business Use of Vehicles

 

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Property Loss

 

 

Initial Form Required:

University of Houston System Property Loss Claim Report

 
 

Timing for Form:

Report of loss to UHD Risk Management for forwarding to UH Risk Management within 24 hours of the incident.

 
 

Timing for Additional Information:

As the information becomes available, also include the police report, any official reports or records, photos, videos and any additional information that will assist in the accident investigation.

 
 

Report Needed If:

Property loss occurs as a result of occurrences such as fire, theft, or natural disasters

 
 

Who is Responsible for the Additional Report(s)/Information?

  • Initial Form - Employee(s) most familiar with the property loss
  • Information Regarding Incident - Employee most familiar with the incident/accident
  • Photos – Environmental Health and Safety
  • Video - Electronic Security Systems Manager
  • Follow Up Reports/Records – Department receiving the reports/information
 
 

Deductible:

  • First $10,000
  • Department/UHD pays deductible  on any funds paid for resulting claims
 
 

Policy Reference:

SAM 01.C.11 - Risk Management - Property Loss Claim

 

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Blanket Insurance Policy Claim

 

For Students injured or sickened as a result of  participating in the following *programs:

 

Department
FY13 Programs

Criminal Justice

-

Basic Peace Officer Academy and Internships

 
  University College

-

Cullen Activities, Freshmen Summer Success Program, and Project Grad Financial Lit

 

Talent Search

-

The Educational Talent Search Program

 

Upward Bound

-

College Prep Central)

 

*Programs subject to change from year to year.

 

 

Form Required:

Special Risk Accident and Sickness Claim Form

03/01/12 to 03/01/13 Accident

03/01/13 to 03/01/14 Accident

 
 

Timing for Claim Form:

Forward claim to UHD Risk Management for forwarding to UH Risk Management within 24 hours

 
 

Timing for Additional Information:

As the information becomes available (reports from witnesses, any official reports or records, photos, videos and any additional information that will assist in the accident investigation)

 
 

Report Needed If:

Student  injured or sickened as a result of participating in the programs covered by “Blanket  Insurance” plans to file a claim

 
 

Who Completes the Report?

This form must be must be completed by both the:

  • Applicable department and
  • Student injured or sickened as a result of participating in the programs covered by “Blanket Insurance”.
 
 

Who is Responsible for the Additional Report(s)/Information?

  • Initial Form - Individual involved in the accident/incident and applicable department
  • Information Regarding Incident - Employee most familiar with the incident/accident
  • Photos – Environmental Health and Safety
  • Video - Electronic Security Systems Manager
  • Follow Up Reports/Records – Department receiving the reports/information
 
 

Deductible:

  • N/A
 

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Page maintained by cookm@uhd.edu

Last updated or reviewed on 5/22/14

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