Get Sedgwick General Liability Intake Form

Filling out the Sedgwick General Liability Intake Form online can be a straightforward process when you understand each section. This guide provides clear, step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to complete the form with ease.

1. Press the ‘Get Form’ button to access the Sedgwick General Liability Intake Form and open it in your preferred editor.
2. Begin by entering the client name and contract number at the top of the form.
3. In the reporter information section, fill in the first name, last name, title, and phone number of the person reporting the incident. Include any necessary extension.
4. In the client location information section, provide the location number, street address, city, state, zip code, and phone number. Specify if this is the loss location.
5. For incident information, input the date of the incident, date the employer was notified, and a description of the incident. Also, indicate the time of the incident using AM or PM options.
6. If the incident location is different from the client location, complete the incident location information section with relevant details.
7. Fill in the authority information by entering the authority name and authority report number, if applicable.
8. For property information, describe the property involved, detail the damage, and provide an estimate amount for repairs.
9. In the owner information section, select the owner type and provide the name, address, phone number, and location details.
10. Provide any other insurance information, including the carrier name and phone number.
11. Enter the information for any involved parties including their first name, last name, home phone, address, date of birth, marital status, gender, and relationship to the client.
12. In the injury information section, describe the injury, its cause, nature, and the specific body part affected.
13. Complete the medical treatment section by indicating if the person was admitted to a hospital, including the hospital or clinic name and its address.
14. Indicate the transportation type if applicable by selecting from the available options.
15. In the witness information section, provide the name, address, city, phone number, and state of any witnesses.
16. Fill out your contact information, including your first name, last name, phone number, and email address. Add any relevant comments or remarks.
17. Once all sections are completed, save your changes, and you can opt to download, print, or share the filled-out form as needed.

Begin filling out your Sedgwick General Liability Intake Form online today for a smooth submission process.