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It is the responsibility of all City / Agency employees to immediately notify
the Risk Manager upon receipt of knowledge or witnessing an occurrence or transaction
from which a potential claim could result or in which the City / Agency could be liable.
This information will give the CALIFORNIA JPIA the opportunity to perform pre-claim
investigation of a significant incident. Prompt reporting is more important than
having completed all of the information. Do not delay reporting while awaiting a
piece of information.
WHAT TO DO IN CASE OF A SIGNIFICANT INCIDENT
- MAKE NO COMMENT AS TO YOUR OPINION REGARDING CAUSE, FAULT OR LIABILITY!
- Notify the Risk Manager as soon as possible.
- Complete this form as follows:
- A. Enter the date and time of the incident.
- B. Identify and enter the name of the person(s) sustaining injury or a description of the property damages.
- C. Describe the exact location where the incident occurred.
- D. Briefly describe how the incident occurred.
- E. Briefly describe the damages or injuries observed.
- F. Describe weather conditions (was surface condition slippery, etc.).
- G. Obtain names, addresses and telephone numbers of persons involved or witnessing the incident.
- If the person involved makes claim overtures to you, advise that claims must be made with the City Clerk.
- If the person does not make claim overtures, do not volunteer information.
- If contacted by the Risk Manager or a CALIFORNIA JOINT POWERS INSURANCE AUTHORITY representative, furnish requested information as accurately and as quickly as possible.
- All persons, other than City personnel, seeking accident information should be referred to the City Clerk or to CARL WARREN & COMPANY, PO Box 25180, Santa Ana, CA 92799-5180, Telephone 714-740-7999 Ext. 140.
- Give other persons involved your name and City address.
- Please include newspaper clippings, police reports or other supplementary information you may have relating to this incident.
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 These
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Significant
Incident Report Online Form