Provide Initial Report within two business day of the incident
(Visit the Employee Accident, Injury or Near Miss site for information on employees.)
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
One Main Building, Room 910S
Houston, TX 77002-1001
Attention:
Stefany Records
Phone: 713-221-8636
Fax: 713-223-7473
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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Form Required: |
Student/Visitor/Contractor Accident Report Form
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Timing for Form: | Report to UHD Risk Management for forwarding to UH Risk Management within two business days 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
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Policy Reference: |
SAM 01.C.09 - Risk Management - Tort Liability (PDF) |
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Initial Form Required: |
Automobile Accident Procedure Reporting Form
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Timing for Form: | Report to UHD Risk Management for forwarding to UH Risk Management within two business days 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
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Deductible: | - $1,000
- Department pays deductible on any funds paid for resulting claims
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Policy Reference: |
SAM 01.C.02 - Risk Management - Allocation of Insurance Premium and Claim Reimbursement (PDF) and
SAM 01.C.13 - Risk Management - Business Use of Vehicles (PDF) |
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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 two business days 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
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Deductible: | - $10,000
- Department/UHD pays deductible on any funds paid for resulting claims
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Policy Reference: |
SAM 01.C.11 - Risk Management - Property Loss Claim (PDF) |
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Accident insurance can afford a limited amount of Excess Medical insurance for University sponsored activities that are scheduled on the policy. Insurable activities include: workshops, camps, seminars held on or off-campus and University sponsored activities which involve students or visitors.
The coverage is in excess over the participant's private insurance, their parents' or guardian's insurance, or any other insurance that would apply.
Form Required:
| Risk Management should be notified in the event of an accident within two business days of the incident so that the appropriate form can be sent to the department for completion.
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Timing for Claim Form: | Forward claim to UHD Risk Management for forwarding to UH Risk Management within two business days.
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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”.
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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
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Deductible: | |
