Risk Management Form

Borrowed Property Insurance Request Form

Posted on February 20, 2025

Use this form to assure property insurance coverage for non-owned items that are borrowed from external parties. Form is routed to Risk Management.

Complete and submit the following form to assure property insurance coverage for non-owned items that are borrowed from external parties. In addition, a final, signed agreement and any pertinent information not included in this form must be emailed to Risk Management at insuranceinventories@bussvc.wisc.edu.

If you plan to borrow an art exhibit from an external party, do not complete this form. Each artist or owner must submit to UW–Madison Risk Management: a signed Art Exhibit Coverage Request Form, an itemized listing of the works to be exhibited by name or description, and an individual value for each item.

Submitter information

Submitter name(Required)

Submitter email(Required)

Submitter phone number

UW–Madison School/College/Division name

Borrowed property details

Has a borrowed loan agreement been reviewed with the UW Capital Equipment team?(Required)

Yes

Proposed loan/borrowed property agreements are to be first submitted to UW–Madison Capital Equipment (at property@bussvc.wisc.edu) for the signature authority process. Capital Equipment will then coordinate review of the agreement with Legal, Risk Management, and Purchasing, as necessary.

The final signed agreement should then be emailed to Risk Management at insuranceinventories@bussvc.wisc.edu to secure insurance coverage as discussed above. Coverage may not be provided unless this is complete.

Borrowed item(s) description(Required)

If necessary, use the plus symbol to the right to add additional items.

Make

Model

Serial number

Replacement dollar value

Lender organization name(Required)

Lender representative name(Required)

Lender representative email address(Required)

Lender organization's business address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Note: For borrowed loan agreements that require multiple loan periods, a new form must be submitted for each loan period.

Start of loan period(Required)

End of loan period(Required)

Will UW-Madison be responsible for transit coverage?(Required)

Yes

UW–Madison is expected to report all shipments (foreign, domestic, and carry-on) valued at $50,000 and greater via the State of Wisconsin Report of Shipment Request for Marine/Cargo Insurance Coverage Form.

This should be done at least 72 hours prior to time of shipping.

Be sure to keep all transit records within the department in case a loss occurs.

Responsible UW employee information

Information about the UW–Madison employee responsible for custody of the asset/property while in UW–Madison possession.

Responsible UW School/College/Division(Required)

Responsible UW School/College/Division employee(Required)

Responsible UW School/College/Division employee email(Required)

Borrowed asset location(Required)

Location of borrowed asset while in UW–Madison possession.

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

The requesting School/College/Division will be responsible for property claim submissions, deductibles, and will be financially responsible for any property claim not covered by the State of Wisconsin Self-Funded Property Program (SSPP).

Please send a final, signed borrowed loan agreement and any pertinent information not included in this form to Risk Management at insuranceinventories@bussvc.wisc.edu.

Phone

This field is for validation purposes and should be left unchanged.

Pre-hire Driver Authorization Check Form

Posted on June 17, 2022

This form is used by departments to request driving records (for Wisconsin drivers) in pre-employment or post-offer situations. Risk Management cannot access out-of-state driving records.

This form is used by departments needing to check an applicant’s driving record in pre-employment or post-offer situations.

You can request up to four (4) driver authorization checks per form submission.

Please note:

Pre-hire driver authorization checks can take up to five (5) business days to complete.
Risk Management cannot access out-of-state driving records.

Requester Name(Required)

First Last

Requester email(Required)

Requester phone number

Department name(Required)

Department ID/UDDS Code

Format: UA-######

Out of state licenses and requests

Please note: Risk Management does not have access to obtain out-of-state driver abstracts.

Out-of-state license holders: To request a pre-hire review, please submit a copy of the Out of State Driving Record/Abstract and a picture of the current driver's license to driverauth@bussvc.wisc.edu.

Request 1

Pre-hire driver name(Required)

Wisconsin Driver's License Number(Required)

The letter at the beginning of the license number must match the first letter of the person's last name. Formatting will look like: [Letter]###-####-####-##

Would you like to add another another Wisconsin driver to check?

Yes

Request 2

Pre-hire driver name(Required)

Wisconsin Driver's License Number(Required)

The letter at the beginning of the license number must match the first letter of the person's last name. Formatting will look like: [Letter]###-####-####-##

Would you like to add another Wisconsin driver to check?

Yes

Request 3

Pre-hire driver name(Required)

Wisconsin Driver's License Number(Required)

The letter at the beginning of the license number must match the first letter of the person's last name. Formatting will look like: [Letter]###-####-####-##

Would you like to add another Wisconsin driver to check?

You may only request up to four driver checks per form submission.

Yes

Request 4

Pre-hire driver name(Required)

Wisconsin Driver's License Number(Required)

The letter at the beginning of the license number must match the first letter of the person's last name. Formatting will look like: [Letter]###-####-####-##

Phone

This field is for validation purposes and should be left unchanged.

UW–Madison Field Trip Guidance

Posted on June 15, 2022

Risk Management guidance for University sponsored field trips occurring as part of a UW–Madison course, program, or event. Includes Field Trip Participation and Emergency Contact Form and Alternative Transportation Waiver for Campus Field Trip.

The Office of Risk Management has created guidance for University sponsored field trips occurring as part of a UW–Madison course, program, or event.

The guidance includes these form templates:

Field Trip Participation and Emergency Contact Form
Alternative Transportation Waiver for Campus Field Trip

ORM UW–Madison Field Trip Guidance (PDF)

Use the “Download” option in Box (button in upper right) to download the PDF. You will then be able to see the fillable form fields on pages 3 and 4.

If you have specific questions related to this document, please email us at riskmgmt@bussvc.wisc.edu.

Dependent Enrollment Form

Posted on June 6, 2019

Dependent Enrollment Form

Download Department Enrollment Form

Non-Employee Incident Report Form

Posted on April 1, 2019

Non-Employee Incident Report Form

*If you are having difficulty completing this online form, please contact Risk Management at riskmgmt@bussvc.wisc.edu.

Vehicle Accident/Incident Report

Posted on July 23, 2018

Vehicle Accident/Incident Report

Download Vehicle Incident Report (PDF)

Form version last updated December 2020.

Art Exhibit Coverage Request Form

Posted on July 23, 2018

Request for Art Exhibit Coverage

This form is used to request insurance coverage for art exhibits taking place on UW–Madison property.

Download Art Exhibit Coverage Request Form

Property Loss Report

Posted on July 23, 2018

Property Loss Report

Use this report form to notify Risk Management about property damages or losses to UW–Madison owned property, equipment, or contents. Learn more about filing property damage claims

Note: A NetID login is required to access the Property Loss Report form.

Complete the Property Loss Report

Lightning Losses Affidavit Form

Posted on July 23, 2018

Lighting Losses Affidavit document

This form must be completed for property claims of damages caused by lightning to UW–Madison owned property, equipment, or other contents. Learn more about filing property damage claims

The Lightning Losses Affidavit form must be completed by a repair firm/person and signed by the department representative. Submit the completed form to Risk Management (propertyclaims@bussvc.wisc.edu).

Download Lightning Losses Affidavit Form (PDF)

Risk Management Form

Borrowed Property Insurance Request Form

Submitter information

Borrowed property details

Responsible UW employee information

Pre-hire Driver Authorization Check Form

Out of state licenses and requests

Request 1

Request 2

Request 3

Request 4

UW–Madison Field Trip Guidance

Dependent Enrollment Form

Non-Employee Incident Report Form

Submitter's Information

Injured Individual/Property Owner

Injury Information

Property Damage Information

Vehicle Accident/Incident Report

Art Exhibit Coverage Request Form

Property Loss Report

Lightning Losses Affidavit Form