Standard Forms

Claims

ORM-CLM-2013-01 Property Loss Report
ORM-CLM-2013-02 Risk Management Incident Report
ORM-CLM-2014-03 Vehicle Loss Report

Student Health Insurance Program (SHIP)

International Student Health F1 Insurance Fee Adjustment Request Form

Transportation

ORM-T-2013-09 Request to Operate Motor Vehicle 
Contract Travel Vendor Exceptions Form

Travel

ORM-T-2013-01 Approval of College Sponsored Student Travel 
ORM-T-2013-02A Trip Plan and Trip Roster Combined      
ORM-T-2013-02 Trip Plan   
ORM-T-2013-03 Trip Roster  
ORM-T-2013-06 Incident Report 
ORM-T-2013-07 Proof of Vaccination
ORM-T-2013-08 Emergency Contact ID Card
OGC-S-2009-10 Participant Release and Indemnification Agreement    
OGC-S-2010-10 Time Away (Independent Travel)  
OGC-S-2009-16 Study Abroad Participant Agreement Assumption of Risk, Waiver of Liability and
Indemnification

Travel Guidelines & Forms for LSCS Students
Travel Guidelines & Forms for LSCS Employees

Workers' Compensation

DWC001 Employer's First Report of Injury or Illness (10/2005)
DWC003 Employer's Wage Statement (10/2005)
DWC006 Supplemental Report of Injury (10/2005)
DWC053 Employee Request to Change Treating Doctor (03/2012)
DWC073 Work Status Report (02/2011)
DWC074 Description of Injured Employee's Employment (09/2009)
Modern Medical Instant Access Pharmacy Program Prescription Fill Card Voucher
ORM-WC-2014-01 Employee Statement of Injury
ORM-WC-2014-02 WC Initial Examination Authorization
ORM-WC-2014-03 Supervisor's Accident Investigation Report
ORM-WC-2014-04 Witness Statement
ORM-WC-2014-10 Responsibilities of the Injured Employee
ORM-WC-2014-10A Responsibilities of the Injured Employee Checklist
ORM-WC-2014-11 Responsibilities of the Direct Supervisor
ORM-WC-2014-11A Responsibilities of the Direct Supervisor Checklist
ORM-WC-2014-20 What is a Compensable Claim?
Injured Employee Rights and Responsibilities (448.2e 09/2013)
Injured Employee Rights and Responsibilities (Spanish) (448.2s 09/2013)
Ombudsman Program Notice
Ombudsman Program Notice (Spanish)
Workers' Compensation E-Document Packet for Employees
Workers' Compensation E-Document Packet for Supervisors