Provide Initial Report within 24 hours 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 and Compliance
One Main Building, Room 621 S
Houston, TX 77002-1001
Phone: 713-222-5340
Fax: 713-226-5546
Attention: 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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Form Required: |
Student/Visitor/Contractor Accident Report Form (docx) |
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 (PDF) |
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Initial Form Required: | Automobile Accident Procedure Reporting Form
09/01/15 to 09/01/18 Accident (PDF) |
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 $1,000 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 (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 (docx) |
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 (PDF) |
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For students injured or sickened as a result of participating in the following programs:
| Department | FY16 Program |
| University College | Cullen Activities, Freshmen Summer Success Program, Project Grad Financial Literature, Summer Fast Start Program, Connections Mentoring Program, Educational Talent Search Program, Honors Program Study Abroad, College Prep Central, Teacher Education Professional Development Semesters (PD1 and PD2) Field work and Student Teaching (PD 3), and Travel to Present Research (Mathematics & Statistics). |
| 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
03/01/16 to 03/01/18 Accident (PDF)
(Instructions for completing the form) (PDF) |
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: | |
