Risk Management & Insurance

 

Below is a list of forms and a few resources for information on insurance and risk in University of Alaska system.  In addition, there is also a list of the "Red Flags" for Risk Management.  If you are coordinating an event, function, or program that will utilize one of the below forms or involves activities listed in the "Red Flags" list, please contact Environmental Health and Safety.  Proper precautions and documentation must be accomplished before activities of this sort are undertaken and EHSRMS would be happy to assist in acomplishing these tasks.

  1. Transportation of people using non-common carriers, (includes personal vehicles), to transport students, guests, and visitors.
  2. Involvement of minors (under the age of 18) in any university program or activity.  See program evaluation and planning tools at:  Minors in UA Programs & Events 
  3. Use of hazardous chemicals or materials in any program or activity.
  4. Performing hazardous activities (extreme sports, wilderness events, ice or mountain climbing, bonfires, use or carrying of firearms, etc.).
  5. Contracts and memoranda of agreements with outside entities that include insurance or indemnification clauses that have not been approved by General Counsel and/or Risk Services.
  6. Foreign travel by employees and students (includes Mexico and Canada).
  7. Paying student salaries through the university system to work for other entities.
  8. Renting vehicles for use by non-employees.

 

Form Name

Blank

Sample

Art Exhibit Record

PDF

 

Board of Regents Designation of Beneficiary

PDF

 

Agreement for use of UA Equipment or Vehicles

There are two forms.  The Statewide form with legal language exists to document the acceptance of liability by the user.  The other Statewide form is used to track the location of equipment of over $5000 dollars worth.  Both forms should be filled out for any personal use of equipment (second form used if worth is over $5k) and kept by department.  The $5k form should be forwarded to Procurement as well.

Liability = PDF

Tracking = PDF

 

UA Special Event Insurance for Use of UA Facilities Only

Link

 

Facilities/Premises Use Agreement

PDF

 

Foreign Visitor Travel Brochure and Application

PDF

 

Loss Prevention Program

PDF

 

Alaska Limited Governmental Notary Commission Application

PDF

 

Sports Camp Insurance

PDF

 

Student Accident Insurance Application, Brochure, and Election/Rejection Form

Link

 

Student Professional Liability Insurance Application

Link

 

Auto Insurance Card

PDF

 

UA Contracting Information and Templates

Link

 

UA FERPA Clause for Agreements Involving Students

PDF