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These are the more common forms used by the Department of Insurance & Risk Management. They are here for you to download and fill out.


EMPLOYEE PARKING

Enrollment

INJURY | PROPERTY DAMAGE  

Report

WORK RELATED INJURY REPORT  

On-line Form

*Form must be opened in Adobe Acrobat or downloaded to your computer in order to be able to fill it out electronically.

On-line Form Questions? Contact: Carolyn Stevenson
Note: You will need an internet connection to use this form.

HIPAA

Amendment

Authorization

Privacy Practice

Privacy Violations

AUTOMOBILE ACCIDENT REPORT  

Vehicle Accident Report Policy and Procedures

Report

MISSING OR STOLEN PROPERTY  

Missing or Stolen Property Report

BENEFIT APPLICATIONS

Enrollment Application County

Enrollment Application Summit County Children Services

Enrollment Application Summit County Public Health

Enrollment Application Veterans Service Commission

Enrollment Application NEFCO

Employee Status Change

OTHER

Health Access Request

Accounting

Restrictions

SUPPLEMENTAL INSURANCE

AFLAC Accident Claim

AFLAC Accident Wellness Claim

AFLAC Cancer Claim

AFLAC Cancer Wellness Claim

AFLAC Disability Claim

AFLAC Request for Addition-Reinstatement

AFLAC Request for Change

AFLAC Sickness (Physician's Visit) Claim

AFLAC Sickness Claim

Allstate Accident Only Claim

UNUM Critical Illness & Cancer Claim

UNUM Customer Service Request

THE END

 
 
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