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The following Risk Management Forms can be accessed via the provided links. For any further information regarding completion or clarification of Risk Management forms please contact (920) 424-3990.
For further information regarding completion of Risk Management Forms please contact (920) 424-3990.

General Incident Report (DOA-6441)

The General Incident Form is used for any accident that occurs on campus. Risk Management encourages the reporting of all incidents, especially if there have been injuries or property damage. Please complete the following form and submit it to the Risk Management Office (Dempsey 236).

General Incident Report

 

Vehicle Accident/Incident Report (DOA-6496)

photo-accident.jpgThis form is required if you have been in an accident with a State Vehicle. This form must be submitted to the Risk Management Office (Dempsey 236) within 24 hours of the accident. Report the accident to law enforcement immediately following the incident; as well as inform the UWO Fleet Vehicle Department (fleet@uwosh.edu) as soon as possible. 

Vehicle/Accident Report

 

Uniform Affiliation Agreement

This form must be used for any field placement or internship where students will be working with an outside agency which agrees to participate in a cooperative effort with the University. This form should be signed by the outside agency before submission to Dempsey 236 for review and approval. 

Uniform Affiliation Agreement

 

Caregiver Addendum

 This form is required for all health care field placements or internships. This completed addendum must be attached to the above listed Uniform Affiliation Agreement. 

Caregiver Addendum

 

Program Memorandum

This document specifies the educational requirements and expectations of the internship or field placement for which both the outside agency and the Dean of the College involved has agreed to. Provided is an example of a Program Memorandum.

Program Memorandum Example

 

 Field Trip/Activity Waiver

This waiver should be completed before participation in field trips or other activities; releasing the University of any risks that may result due to participation. 

Field Trip/Activity Waiver

 

Facility Use Form

This form should be completed by any organization who is using University facilities for non-university sponsored activities and/or programs. 

Facility Use Form

 

Volunteer Form

This form is for volunteer services entered into by and between a Volunteer Agency and UW-Oshkosh. The specific responsibilities to which both the Volunteer Agency and UW-Oshkosh agree to are specified in this form.

Volunteer Form

 

Notice of Claim Form

This form should be completed when an individual is claiming damages, injuries, or death resulting from an encounter which occurred due to the negligence of a state officer, employee or agent or on state property. This form must be served by certified mail within 120 calendar days of the event. This form must also be notarized by a Public Notary of the State of Wisconsin. 

Notice of Claim Form

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Affiliation Agreements

Affiliation Agreements

Affiliation agreements are contracts used to place students in either clinical or field placements for internships.

Affiliation agreement for clinical (pdf)

Affiliation agreement for field placement (pdf)

Program memorandums are also required for placements, but are separate from the affiliation agreement.

Program memorandum-sample (pdf)

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General Incident Report

DOA-6441

Microsoft Word Document icon General Incident Report Form (DOA-6441).doc — Microsoft Word Document, 69 kB (71168 bytes)

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