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Forms

 

During Shelter-in-Place: Email completed forms to risk@fhda.edu.

Returning to Campus: Forms may be sent to risk@fhda.edu (preferred) or sent via interoffice mail to the attention of Risk Management.

 

FORM TITLE 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.
Ergonomic Evaluation Request For ergonomic evaluations and minor workstation adjustments; employee must first complete a self-evaluation per the "Ergonomics Guide for Computer Workstations" available in MyPortal under the Employee Safety Resources tile.
Insurance Certificates To request an insurance certificate for proof of coverage.  If an Additional Insured endorsement is required, include a copy of the agreement that requires such endorsement.
Safety Issue Report To facilitate the reporting of hazards. Submit a Facilities Work Order/Service Request or alternatively complete this form.
Student Fieldtrip/Excursion Request Form To assure insurance coverage for staff, students and the District for proposed travels as a college sponsored activity.
Student Fieldtrip/Excursion - Minor Authorization The Minor Authorization Release is for students under 18 years of age and must be completed and on file prior to the field trip/excursion.
Voluntary Assumption of Risk The assumption of risk and release of liability must be completed by the student and on file prior to the field trip/excursion.
Volunteer of Record Volunteers must be approved prior to start of service; volunteers can assist, but may not take the place of a faculty, staff, or union position.

The Volunteer-of-Record (VOR) Program is modified to reflect COVID-19 Pandemic requirements and/or mandates, and shall be in effect until further notice. During this time, Risk Management will approve Volunteer-of-Record forms BY EXCEPTION ONLY upon college President or Vice President of Administration approval, unless a program has officially returned to on-campus instruction/participation.  Additionally, all Volunteers must comply with Board Policy 3507 'COVID-19 Vaccination Interim Policy' and must complete and return a vaccination Self-Certification form prior to approval.