Intake

Claim Intake

  • All sections highlighted in yellow must be completed.
  • General Intake FormSchool Incident Report Form
  • School Incident Report Form For Insurance Purposes

  • 1 General
  • Add Witnesses   




















  • 2 Injury/Loss Details

  • SECTION A
  • Add Injured Person   





























































  • SECTION B

















  • 3 Submitter Information