Forms - Golden State Risk Management Authority

Forms

Claim Forms

Form Completion Instructions Claim for Damages Accident Incident – Schools Only Auto Loss Notice Incident Report Property Loss Notice WC Mileage Form 2023 July 1-Dec 31 WC Mileage Form 2024 OSHA Form 300 OSHA Form 300A, 301 Time of Hire Pamphlet DWC Form Form 5020

Employee Benefits Forms

2024 GSRMA Health, Dental, Vision, & EAP Enrollment Form 2024 GSRMA Employee Benefits Brochure

Loss Prevention Forms

School District Employee Training Matrix Risk Management Accreditation Program (RMAP)Loss Prevention Subsidy Fund (LPSF) request

Member Services Forms

Volunteer Workers’ Compensation Coverage – Information Page Workers’ Compensation Coverage for Unpaid Volunteers – Declination Workers’ Compensation Resolution – Board Only – Sample Workers’ Compensation Resolution – Board Only Workers’ Compensation Resolution – Board and Volunteers – Sample Workers’ Compensation Resolution – Board and Volunteers Workers’ Compensation Resolution – Volunteers Only – Sample Workers’ Compensation Resolution – Volunteers Only

Miscellaneous Forms

Certificate Request Member Expense Form 2025 Member Expense Form 2024

Miscellaneous Resources

Insurance Requirements in Contracts(IRIC)