Damage report for possible insurance claims processing

The following report is to be filled out and submitted to Insurance and Claims Services for all damages, including but not limited to automobile accidents and damage to state-owned property, state-owned buildings (including water damage) or personal property.

If the loss was due to criminal activity (graffiti, theft, vandalism) or involves a vehicle accident or injury, please contact NAU Police Department dispatch FIRST at 523-3611 to file a police report and then follow up with filing this report.

Instructions:

  • Fill out all fields as completely as possible
  • Remember to include descriptive information
  • In the event of water damage to state facilities, refer to the “WATER DAMAGE RESTORATION GUIDELINE” procedures
  • Move from one field to the next by pressing the “TAB” key or use your mouse. DO NOT PRESS ENTER or this will close and submit the form.
  • A copy of the information you enter on this form will be sent to the email address you entered after you click “SUBMIT”
  • If you have any questions or concerns about this report or the process for damaged property, please contact Insurance and Claims at (928) 523-2009
  • If necessary, a representative from Insurance and Claims Services will contact you for additional information

NAU (State-owned) Property: When property of the state (Northern Arizona University) is damaged, this online Damage Report must be completed to initiate the claim process with State Risk for reimbursement.

Personal Property: If you feel your personal property was damaged or you were injured as a direct result of University responsibility, you may file this online damage report. Any additional forms you may need to file a claim against the State will be sent to your attention. For example, an NAU employee accidently damages your electronic equipment while repairing your residence hall room.

For more information on coverage please review the information at the Insurance and Claims Services website including the Frequently Asked Questions section.

 

Check type of report

Date & location information

NAU campus location

Reporting party information

Driver and state vehicle information

The following information must be provided for damage to state vehicles or damage to rental vehicles used for university business

Information on state vehicle damaged

ESTIMATED amount of loss?

Description of damaged property

Describe damage to State vehicle or property: (example: windshield cracked by rock, or DELL OptiPlex GX1p Computer received water damage.)

Narrative

Include any additional remarks and actions taken.

State property losses that are not reported to Insurance and Claims Services in a timely manner may not be covered.

State property losses not reported to State Risk Management within 90 days of the incident will not be covered.