Forms

Automobile Insurance

Personal Vehicle Flyer
Automobile Loss Notice Form (PDF Version)
Automobile Loss Notice Form (Secure Online Version)
Risk Management memo re: Rental Car Physical Damage Coverage

Educators Liability Trust Fund (ELTF)

Educators Liability Trust Fund Announcement Letter
Educators Liability Trust Fund Claim Form (PDF Version)
Educators Liability Trust Fund Information Flyer
Educators Liability Trust Fund Guidelines
Enabling Legislation

Employee Assistance Program (EAP)

EAP Supervisor's Referral Form
EAP Supervisory Referral Fact Sheet
EAP Wallet Card
Wallet Card instructions: Open the document in Word and print to Avery Business Card Stock 5882.

General Liability Trust Fund

AG Proposal to Settle
AG Proposal to File
Status Report Form
GLTF Guidelines
Enabling Legislation

Notary Applications

Notary Public Bond Letter Change

State Employees Injury Compensation Trust Fund (SEICTF)

Accident Report -Employee's Statement
Address Verification - Form 9
Authorization for Initial Treatment and Pharmacy -Form 3A
Authorization for Release of Health Information - Form 8
BBP Supervisor Instructions
Blood/Body Fluid Exposure Report - Form 7
Employee Election for Lost Time Benefits - Form 2
Employer's First Report of Injury - Form 1 (New Online Version)

NOTE: Due to security reasons, this application can only be accessed by agencies in the campus network. If you can not access this form, please use the printable version located on this site. Contact your agency IT department if additional assistance is needed.

Employer's First Report of Injury - Form 1 (Printable Version)
Gatekeeper List
Helpful Tips & Information about SEICTF Benefits
Medical Provider Pre-cert Form
Mileage Request - Form 11
Notice to All Employees
Pharmacy Card
SEICTF ID Card
Supervisor Instructions for On the Job injuries
SEICTF Guide to Benefits and Claims Filing

State Property Insurance

Property Insurance Request
Property Loss Notice Form (PDF Version)
Property Loss Notice Form (Secure Online Version)
Lightning Affidavit