Incident ReportingThe safety and security of our students, employees, and visitors is one of the District’s highest priorities. Please report injuries and illnesses as soon as possible using the following forms and guidelines:
Non-Employee Illness/Injury Incidents involving students, visitors and vendors/contractors, should be reported to the Vice Chancellor of Administrative Services, the Risk Manager, and the College President where the incident occurred using the
Non-Employee Medical Incident Report Form
Student-related injuries and illness claims - For students requiring medical care as a result of inuries/accidents on campus, provide them with the Student Injury Claim Form after the incident has been reported. Please note both the student and College official must complete the forms. Send completed forms to the Risk Manager.
Work-related injuries and illnesses involving employees, volunteers, student employees, and clinical nursing/medical assisting/dental assisting students should be reported to Michelle McKay, Benefits Analyst, Human Resources at 408-223-6713. Workers’ Compensation forms and additional information can be found at:
Campus Property Safety Concerns Reporting Form - Employees can use this form to report any property safety concerns.
Risk Management Forms
Employee Safety Recommendation Form
Personal Vehicle Use Form - This form should be filled out by any District employee using a personal vehicle for District business, including field trips, at least 3 days prior to use. Dean or other supervisor must sign as Site Administrator Approval.
Liability Certificate of Coverage Request - Use this form to request a Certificate of Insurance (COI) in connection with contracts, Memoranda of Understanding or other agreements.
Student Activity & Field Trip Waiver of Liability - This form should be filled out and signed by all students (and parents or guardians if students are minors) at least 3 days prior to their participation in school activities and field trips.
Waiver of Liability Agreement - Volunteer - Please have volunteers sign this form 3 days before the day of the event or activity. The event or activity coordinator should retain the Waiver for one year.
Contract Requirements for Buses and other Transportation Services - Please refer to this for the additional requirements which must be met when the District contracts for bus or other transportation services.
Injury & Illness Prevention Program - The Injury & Illness Prevention Program provides District employees with information to ensure a safe work environment.
Requirements for Certificates of Insurance - The District must be listed as an Additional Insured on the General Liability policy of the contractor, vendor or MOU partner. This document contains instructions for what language must be included on the Certificate of Insurance.
AP 4300 Field Trips and Excursions
AP 6530 District Vehicles
NEWS/MEMO ARCHIVEGovernor EO N-6-22 (Russia Sanctions)