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Forms

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Safety and Loss Prevention Forms

  • Accident Report Form (Preferred method for reporting - online reporting of accidents) To be filled out in the event of an accident or medical incident on campus. Complete report within 24 hours of accident/incident.
    Accident Report Form (open, download, and print for a paper copy form; however, the online reporting form is preferred)- To be filled out in the event of an accident or medical incident on campus. Complete report within 24 hours of accident/incident and route to Public Safety in Red Cedar Hall room 119. If filing a Workers' Compensation claim, this form must still be completed.
  • Driver's Education Waiver - To be filled out by students and/or guardians (if student is under 18) prior to enrolling in Driver Education programs at LBCC. The purpose of this warning is to bring attention to the existence of potential dangers associated with the participation in Driver's Education classes. It is the participants' responsibility to inquire about any concerns they might have regarding the safety of class participation.
  • Driver Status Form 2014-2015 (employees and students) - Any person wishing to drive as an agent for LBCC, or to be reimbursed for mileage attained while driving to/from work-related events, must complete and submit this form. Drivers must be approved based on Motor Vehicle Records.
  • Driver's Status Form for Volunteers/Driving as a Volunteer - To be filled out by LBCC volunteer drivers. LBCC's insurance carries excess automobile liability for volunteers. This will provide coverage for liability over volunteers' personal automobile coverage if they use personally owned vehicles while participating in authorized, college-approved and sponsored activities. 
  • Driving As Agent - To be completed prior to driving a college-owned or -rented vehicle.
  • Informed Acknowledgement of Hazards and Risks - This is a standard template for Risk Acknowledgments. Actual Risk Acknowledgments are created specific to the hazards presented by a class or a class activity (such as a field trip). Thus, any requests for Risk Acknowledgments for a particular class or activity should be directed to the Safety & Loss Prevention Manager.
  • Risk Acknowledgement Form for Exercise and Activity Classes - This is a template for Risk Acknowlegement. This Risk Acknolwlegement is specifically for the Exercise and Activity Classes offered at LBCC and should be directed to the Safety & Loss Prevention Manager
  • Loan Equipment Form - To be filled out by any student wishing to borrow equipment from LBCC. Borrower is responsible for the compensation of any lost or damaged equipment.
  • Release of Liability - Student Driving on Own - Waiver form to be filled out by students wishing to provide their own transportation to college-related events.
  • Volunteer Form - Acknowledgment that volunteer provides services through his/her own free will and without expectation of receiving wage payment for these services. Also verification of possible previous criminal conviction. A new volunteer form must be completed every school year.
  • Hot Works Program - Guidelines and checklist for safe operation of temporary projects involving open flame or producing heat and/or sparks. The permit applies only to a specific job, in the area specified, during the time and date listed. Permit must be completed and approved prior to starting any hot works projects. 
  • Student Travel Forms - A series of forms for students traveling for college-related activities, to be completed and submitted prior to leaving. Includes Emergency Contact, Medical Information and Travel Checklist and Tips.