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BYUH BUILDING & STRUCTURES
LOSS - CLAIM FORM

(For Building Contents or Other Moveable Property Use: BYUH Property-Loss Claim Form)

Note: Please read general guidelines before completing this form

THE INCIDENT
 
Date Occurred:
Time:
AM
PM
What happened:
 

THE PROPERTY
 
Building/Structure:
 
Area damaged (interior/exterior/N.S.E.W./floor/room No./etc.):

DOCUMENTATION
 
This form (or equivalent memo) and the following are required before payment can be made. Please turn in this claim form first. You can turn in the documentation listed below at a later time:
   
  1) Detailed repair estimate and invoice (PR or PO not accepted by Church).
  2) The BYUH dept. and account number to be credited by RM&S:
  - Department:
  - Account number:
  If an alternative accounting procedure has been or will be used please describe:
 
  3) Vandalism or damaged by a licensed vehicle: Police Report or Report#:
 

_____________
_____________
_____________
_____________
(Signature)
(Title)
(Date)
(Campus Address)
       



GENERAL GUIDELINES:
1.
Only losses exceeding a $100. Threshold will be considered for coverage.
2.
Risk management should be notified of loss as soon as possible.
3.
Not all losses are covered. Coverage is based on a standard property insurance policy.
4.
Coverage is for replacement materials similar in kind and quality to the originals.
5.
Upgrade differences should be paid by the department
6.
Claims expire one year from the occurrence date. Documentation must be received by then.


BYU-HAWAII RISK MANAGEMENT

PHONE: 293-3675 * FAX: 293-3657 * EMAIL: lawrence@byuh.edu

 

BYUH will only pay for damage to the personal property of University personnel, students, and visitors, etc when BYUH is responsible for causing the damages or when one of the following applies:

The property of BYUH personnel is damaged during the course and within the scope of employment and is used with the knowledge and approval of the supervisor or department chair, dean or director.

OR

The property of others is damaged during the course and scope of an officially approved activity or during activity-related transport in a University or University-rented vehicle, and used with the knowledge and approval of the director of the activity and APPROVED BY RISK MANAGEMENT AND SAFETY PRIOR TO THE ACTIVITY.

In addition to the above, BYUH will only pay for damage to the personal propery of University personnel, students, and visitors, etc., when ALL of the following apply:

Coverage is secondary to all other collectible insurance such as renter's and homeowner's.

The owner of the property must have exercised reasonable care to protect the property before and after any loss.

The property loss must be reported to Risk Management and Safety within 30 days.

Valuation will be at the actual cash (used) value of the property rather than what it would cost to replace it with a brand new item. Otherwise, coverage is based on the same coverage as BYUH property.

Personal property used primarily for the pleasure, entertainment or convenience of personnel will not be covered by the University. Items that are typically worn, such as clothing, watches, eye wear, engagement and wedding rings, are generally not covered.

Risk Management Links
Workers' Compensation
TDI
Points of Interest
Sexual Harassment

Risk Management Forms
Vehicle Accident Investigation Form
Witness Statement Form
Employee Accident Report
Facts of Accident
TDI
BYUH Property-Loss Claim Form
NONBYUH Property-Loss Claim Form
BYUH Building & Structures Loss-Claim Form
BYUH Report for Nonwork-Related Injuries
Request For Certificate of Insurance