Emergency Services Claim Forms
Have you had an accident in a county vehicle, loss of property or personal injury?
Here are some things that need to be done to expedite the insurance process for you and your supervisor, captain or chief
- PERSONAL INJURY A. ACCIDENT CLAIM FORM (within 24 hours)
- AUTO ACCIDENT (BOTH NEED TO BE PLACED IN THE VEHICLE) A. AUTO INSURANCE CARDS
- CITIZEN INJURY CLAIM CLAIM FORM (SOMEONE OTHER THAN EMPLOYEE WHO GETS HURT, within 24 hours)
- PROPERTY, EQUIPMENT CLAIM A. PROVIDE INCIDENT REPORT
B. PHYSICIAN’S STATEMENT (within 2 or 3 days after)
C. REPORT OF ACCIDENT WORKER’S COMPENSATION (within 24 hours)
D. WORKER’S COMPENSATION CLAIM FORM (while in ER or Dr’s Office)
a. OSHA Form 301 (within 7 calendar days) if a recordable injury
B. ACCIDENT CARDS
C. CLAIM FORM (Attach copy of police report, within 24 hours)
B. OBTAIN TWO WRITTEN QUOTES TO REPLACE ITEM (within 24 hours)
