Forms

Email completed forms to [email protected] (preferred) or send via interoffice mail to the attention of Risk Management.

FORM TITLE	INTENDED PURPOSE
DMV Driver Record Release	Only Employees and Volunteers of Record who have been cleared through Risk Management are authorized to drive District vehicles. Complete the DMV Driver Record Release Form for authorization to drive a District vehicle, including Electric Carts, Gators, and similar types of vehicles. Submit this form at least one week before the first driving activity date with the District Approval Signature to allow for processing.
Insurance Certificates	To request an insurance certificate for proof of coverage. Include a copy of the Contract Agreement when an Additional Insured endorsement is requested.
Fieldtrip/Excursion Request Form	To establish the proposed travel as an officially recognized college sponsored Activity (Completed by the Instructor/Advisor).
Fieldtrip/Excursion - Release of Liability and Assumption of Risk Form	To be completed by the Student/Participant and submitted to the Instructor/Advisor at least 10 days in advance of the proposed Fieldtrip/Excursion.
Non-Employee Injury Incident Report Form	The safety and security of our students and visitors is one of the District’s highest priorities. Please report injuries involving students or visitors as soon as possible using this Form.
Student Accident Insurance Claim Form	The District provides students with accident insurance through Mutual of Omaha Insurance Company. If a student is injured on campus or while participating in a District-sponsored activity, use the Student Accident Insurance Claim Form to submit a claim for benefits. Please note that this coverage is secondary to the student's primary health insurance. Follow the instructions provided on the claim form when submitting a claim. Student Accident Insurance Brochures The brochures below provide an overview of the student accident insurance program, including eligibility, covered benefits, exclusions, limitations, and claim procedures. These documents are provided for informational purposes only. Coverage is subject to the terms, conditions, limitations, and exclusions of the insurance policy. De Anza College Student Accident Insurance Brochure Foothill College Student Accident Insurance Brochure
Supervisor’s Claim & Safety Report of Accident	Supervisors must complete this form to report any workplace accidents or incidents involving employees. Once completed, please submit the form to [email protected]u. For incidents involving employee injuries, detailed information about seeking medical care is available at this link: https://hr.fhda.edu/benefits/_workers-comp.html. Contact the Human Resources department for additional questions.
Volunteer of Record	All Volunteers are required to complete a LiveScan criminal history background check through the District Police Department and must be approved by Risk Management prior to start of service. Volunteers can assist, but may not take the place of a faculty, staff, or union position; reference the attached VOR Process Flow Chart that describes the general process.
Voluntary Activity Waiver - Assumption of Risk and Release of Liability and Indemnity	This Voluntrary Activity Waiver is designed to inform and protect participants engaging in activities within the District. By signing this form, participants acknowledge and assume the inherent risks associated with the activity, thereby releasing the District from any liability for injuries or damages that may occur. It serves as a clear agreement between participants and the District, ensuring a mutual understanding of responsibilities and promoting safety during all activities.