Topic: PROPERTY INSURANCE - Page 1 of 3
Reporting a Loss Date Issued: June 23, 1994
Section: LIABILITY/PROPERTY Date Revised:
INSURANCE PROGRAM
Number: XXIII.6.
PURPOSE:
To establish
county-wide procedures for reporting property losses.
POLICY:
It is
the policy of the County of Santa Cruz that all property losses be
reported
to the Risk Management Division of the Personnel Department.
PROCEDURE:
1. Departments shall report all property
losses to the Liability/Property
Program Manager at 454-2240. If a major loss (fire, flood, etc.)
occurs outside of normal working hours,
the department head or desig-
nee shall notify County Communications (9+911)
and request that Risk
Management be notified.
2. Departmental staff shall obtain the name,
address, phone number of any
witnesses to a loss and as many details
as possible.
3. Departmental staff will complete the County
of Santa Cruz Loss Report
- PER5013 immediately, SAME DAY, while
the details of the incident are
fresh.
4. The completed form PER5013 shall be
forwarded to Risk Management with-
in 24 hours of the incident.
5. Copies of all photographs, receipts, time
logs, and any other documen-
tation used to abate a loss shall be
forwarded to the Liability/Prop-
erty Program Manager.
6. The Liability/Property Program Manager and
Risk Manager will coordi-
nate adjusting losses with the
appropriate insurance company. All
questions, comments and concerns about
the incident should be referred
to the Liability/Property Program
Manager.
XXIII.6.
Page 2
of 3 PROPERTY
INSURANCE - Reporting a Loss
7. The Risk Manager should be contacted in any
case if the Liability/
Property Program Manager is not
available.
SEE NEXT PAGE FOR FORM
PER5013
COUNTY OF SANTA CRUZ PROPERTY
LOSS REPORT
XXIII.6.
PROPERTY
INSURANCE - Reporting A Loss
Page 3 of 3
COUNTY OF SANTA CRUZ - PROPERTY
LOSS REPORT
Date of
Loss:__________________________ Time of Loss:_____________________
Employee
Reporting Loss:__________________________________________________
Department:______________________________________Phone
No.:_______________
Exact
Location of Loss:___________________________________________________
__________________________________________________________________________
Description
of Loss (use back if more space needed):______________________
__________________________________________________________________________
__________________________________________________________________________
Estimate
of Amount of Loss:_______________________________________________
__________________________________________________________________________
Did
Fire Respond: __ Yes __ No If yes, Name
and Agency___________________
Did
Police Respond: __ Yes __ No If yes, Name and Agency__________________
Did
County Staff from Other Departments Respond: __ Yes __ No
If yes,
provide name(s) and department(s):________________________________
__________________________________________________________________________
Witnesses: Name, Address and Phone Number
1.
______________________________________________________________________
______________________________________________________________________
2.
______________________________________________________________________
______________________________________________________________________
3.
______________________________________________________________________
______________________________________________________________________
Report
Completed By:____________________________________ Date:____________
FORWARD
COMPLETED REPORT TO RISK MANAGEMENT WITHIN 24 HOURS OF INCIDENT
PER5013
***PAM2306
RFT F1 01/10/01