Risk Management Forms

Public Injury Report

• UIUC/UIS Public Injury Report[posted: 2/01/16]
  Form to be used at UIUC or UIS to report incidents of public injury.
• UIC Report Form[updated: 1/27/10]
  Form to be used at UIC to report incidents of public injury and/or property damage.

Property Damage Report

• UIUC/UIS Property Damage Report[posted: 2/01/16]
  Form to be used at UIUC or UIS to report incidents of property damage.
• UIC Report Form[updated: 1/27/10]
  Form to be used at UIC to report incidents of public injury and/or property damage.

Gaming Liability Insurance

• 4-H Horse Gaming Liability Insurance Application - University Use Only(Web Form)

Academic Camp Forms

• UI Academic Camps Accident Insurance Enrollment Form - University Use Only(Web Form)
• Camp Accident Claim Form - University Use Only[updated: 11/29/07]

Transit Insurance

• Transit Insurance Request Form - University Use Only(Web Form)

Evidence of Liability Insurance

In accordance with U of I System policy, the University Office of Risk Management is the only office permitted to issue evidence or proof of coverage. Requests from other contracting parties related to the University's insurance programs need to be directed to the University Office of Risk Management. To expedite requests please click on the applicable link. Should you feel none of these links apply to your particular request please call (217) 333-3113.

Insurance Certificate

Please Note: If the certificate holder requires that they be named an additional insured, a fully executed agreement is required before a certificate can be issued.

• Request for Proof of General Liability Coverage - University Use Only(Web Form)
  Form should be used for contracts, department-sponsored events held at offsite locations, etc.
• Request for Proof of General Liability Coverage - University of Illinois Extension - University Use Only(Web Form)

Request for Proof of Coverage

Request for Proof of Liability Coverage – Medical Professionals, Residents, or Students (University Use Only)

Use this form to request proof of liability coverage for:

• Current or former medical professionals
• Current University of Illinois medical residents (requests submitted by department program coordinators)
• Current students in approved practicums (requests submitted by program coordinators)

Note:

• All College of Medicine Residents must contact their department program coordinator.
• Only department program coordinators may submit requests for medical resident rotations.
• Only program coordinators may submit requests for current student practicums.
• If an individual is no longer a University resident or student, see the For External Organizations and Individuals section below.

Track Your Certificate Requests

View or Track Your Submitted Requests

Use this link to:

• View requests you have submitted
• Check the status of your requests
• Access prior requests and regenerate certificates as needed

For External Organizations and Individuals

Request for Proof of Medical Professional Liability Coverage (Web Form)

For external organizations or individuals requesting proof of coverage for current or former medical professionals for credentialing purposes.