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Forms
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Volunteer Driver
In order to be a parent driver volunteer
you must meet specific insurance and driving history conditions. Any
person driving their personal auto for a Douglas County School District
event must maintain minimum liability limits on his or her personal
auto policy of 100/300 with Uninsured/Underinsured coverage. The
automobile being used for transport must be equipped with one seat belt
for every passenger and be in safe mechanical condition. Booster seats
must be utilized for any child less than 40 pounds or under 6 years of
age per Colorado State Law. A driver will not be authorized who is
under the age of 21 or who has been convicted of Driving Under the
Influence, Driving While Impaired or Reckless Driving in the past five
years. Other specific circumstances may also prevent authorization of a
driver. If
you are interested in driving your personal vehicle for a school
sponsored activity please print out and complete the following
volunteer driver form. The form will need to be submitted to the
applicable school's Principal at least two weeks prior to the event.
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Liability Claims
A Liability Loss form must be completed if there has been a monetary
loss for which you hold Douglas County School District legally
responsible. Once this form is completed and received in the Risk
Management office, the claim will be submitted to our Third Party
Administrator (TPA). The TPA will then properly adjust the claim and
make a determination of liability.
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Property Claims
The Property Loss claim form is an internal document which needs to be
completed if there has been any loss or damage to Douglas County School
District property resulting from a covered incident. If the loss is a
result of a criminal event (i.e. theft, vandalism) the claim must be
immediately reported to the Security Department at (303) 387-9999. The
Security Department will then assign a Security Incident Report number
to the claim. Without this number, there may be no coverage for the
loss. Once the claim is received and accepted by Risk Management, the
cost of repair/replacement will be transferred via an Intra-District
Charge Form.
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 Student Accident Report
Student Accident forms are to be completed by a representative of the
school where the accident took place. These forms are for internal use
only and are used to track possible trends so that preventative
measures may be utilized. Serious accidents, such as those requiring
paramedic response must be report immediately to District Security at
(303) 387-9999.
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Workers' Compensation
A Workers' Compensation claim must be reported in
writing within four days of the injury per State Law. However, we do
ask that Risk Management is notified immediately. Any and all medical
treatment resulting from a work related injury must be given by the
workers' compensation physician which Risk Management will direct you
to upon initial notification. If you choose not to utilize the workers'
compensation physician, your medical bills and lost-time associated
with the claim will not be covered under the workers' compensation
plan. It is imperative that Risk Management be notified immediately if
medical treatment is warranted so there is no delay in treatment.
Once
the claim is submitted to Risk Management, we will forward your
information to our third party administrator (TPA) who will then adjust
your claim. Benefits under the workers' compensation program include
payment of medical bills and lost time if designated by the treating
physician. Per State Law, the first three full missed shifts can not be
covered under workers' compensation. After the first three missed
shifts, if lost time is authorized by the treating physician, the
injured worker will be paid 2/3 of his/her average weekly wage.
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Facility Inspection Checklist
The Facility Inspection Checklist has been developed
by a core group of School Head Custodians and Risk management with the
intent of reducing school safety and liability exposures. Formally,
Head Custodians need to complete this checklist twice a year (each
February and August). This is just another tool for the schools to use
to help address safety and liability exposures in the district
schools. It in no way replaces any of the current building request for
repair procedures, i.e. the work order system.
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