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LeAnne Hotchkiss
Insurance Claims Manager
850-644-7683

Mary Parker
Senior Program Assistant
850-645-7716

Amanda Boor
Insurance & Claims Manager
850-645-7736


Alternate Contacts

Laymon Gray
Assistant Director
850-645-2279

EH&S
Main Office
850-644-6895

EHS / Risk and Insurance Services / Risk Management / Forms

Format
Form Number Form Name
web* xls doc pdf
      EHS 2-1 General Liability Loss Report
      EHS 2-2 Building Insurance Request Form
      EHS 2-4 Insurance Request Form
    EHS 2-6 Incident Report
  EHS 2-7 Camp Insurance Request Form
      EHS 2-9 Automobile Accident Report
    EHS 2-11 General Liability Claimant Checklist
    EHS 2-12 Automobile Claimant Checklist
      EHS 2-13 Building Deletion Form
    EHS 2-14 Golf Cart, Utility Vehicle and All-Terrain Acknowledgement Form
    EHS 2-15 Golf Cart, Utility Vehicle and All-Terrain Vehicle Annual Safety Inspection Checklist
      EHS 2-16 Lien Disclosure Statement
      EHS 11-1 First Report of Injury or Illness (AKA Notice of Injury)
    EHS 11-2 Accident Investigation Report
      EHS 11-3 Request for Taxpayer Identification Number and Certification (IRS W-9)

*Web forms require FSUID Login