Student Accident Claim
Form Purpose:	This form is from the insurance company to be used from reporting student accidents involving injury or illness.
Format:	PDF (fillable and printable from this web site)
Administrative Rule and/or Procedures:	All Student Accident Claims must be submitted through the Environmental Health Safety and Insurance Office. Completed Student Accident Claim Forms must be submitted to Department Chair immediately following the incident, and then sent in to EHS and Insurance Office within 5 days of the incident. All completed forms and itemized bills must be mailed or faxed to the following: EHS and Insurance Office 9101 Tuscany Way Austin, Texas 78754 Fax: (512) 223-1035 Phone: (512) 223-1015 EHS Office will then submit claims to the insurance company.
Access:	Available to ACC employees only (Must be viewed from within the ACC Network)