AGENCY: Box Elder County School District (Utah). Department of Business Administration

SERIES: 14758
TITLE: General liability accident report
DATES: 1980-
ARRANGEMENT: Chronological, thereunder alphabetical by location

DESCRIPTION: Accident report form completed and sent to the district's insurance carrier on accident's where a student was seen or treated by a medical provider (or absent for more than one-half day) or where school liability is an issue. . Includes policyholder name, address, and telephone number; accident's date, time, location, first notification, and name of person making notification; description of accident or occurrence; injured person's name, marital status, age, address, telephone number(s); nature and extent of injuries; name of doctor or hospital; probable cause of accident or occurrence; property damage; names, addresses, and telephone numbers of witnesses; name, position, and telephone number of person completing form; name of person reporting incident; name of person receiving report; date; signature of person completing report; and any remarks.

RETENTION

Retain for 5 year(s)

DISPOSITION

Destroy.

RETENTION AND DISPOSITION AUTHORIZATION

Retention and disposition for this series were specifically approved by the State Records Committee.

APPROVED: 11/1995

FORMAT MANAGEMENT

Paper copy: Retain in Office for 5 years and then destroy.

APPRAISAL

Administrative

This disposition is based on the administrative needs expressed by the administrative needs expressed by the business official.

PRIMARY DESIGNATION

Private