Report of Visitor Injury

1. CCSD Site will complete the Notice of Accident, Personal Injury/Property Damage form after rendering any necessary first aid. The visitor should be referred to Risk Management for any questions regarding payment of medical bills.

2. The Notice of Accident, Personal Injury/Property Damage form should be forwarded to Risk Management for review.

3. The site administrator will assist Risk Management in conducting an investigation into the circumstances causing the injury. This would include written statements from anyone who witnessed the incident or has knowledge of what happened.

4. Once the investigation is complete all documentation should be forwarded to Risk Management.

5. Upon request of the injured individual, Risk Management will send out a claim form to be completed.

6. Risk Management will issue a determination of coverage and advise the claimant of that determination.

Click here to download Personal Injury Damage Form

Click here to download Witness Statement Form