Get General Liability Incident Report Form - Mesirow Financial

Filling out the General Liability Incident Report Form is an essential step in documenting any incidents that may lead to claims. This guide will walk you through each section of the form, ensuring that you have the necessary information to complete it accurately and efficiently.

Follow the steps to fill out the General Liability Incident Report Form online.

1. Press the ‘Get Form’ button to access the document and open it for editing.
2. Begin by filling out the insured section with the name, contact name, phone number, address, city, state, zip code, email address, location of the incident, location code, and fax number.
3. Next, in the carrier information section, provide the name of the insurance carrier or third-party claims administrator and the policy number.
4. Proceed to the claimant information section. Fill in the name, age, sex, marital status, address, city, state, zip code, phone number, and email of the person involved. If the person is under 18, include the name, address, phone number, and email of their parents or guardians.
5. In the reported by section, enter the name of the person reporting the incident, along with the date and time it was reported (including am/pm). Also, note the date and time of the accident.
6. For the incident information, indicate if there was bodily injury and provide a description. Confirm whether medical assistance was requested by answering yes or no.
7. Next, describe any damaged property, noting whether it was reported or not. If there was damage, indicate who requested assistance and where treatment was provided.
8. State the value of the damaged property and provide the contact information of the injured party or property owner, including their relationship to the incident.
9. Document the nature of the injury or property damage as described by the injured party or property owner, and provide a detailed account of what happened and the precise location of the incident.
10. Record the prevailing weather conditions during the incident by checking the appropriate box.
11. List any additional information obtained following the incident and indicate if there are any attachments, such as sketches, maps, or reports.
12. Include witness information, listing names, addresses, home phone numbers, and their relationship to the incident.
13. Finalize the report by including the name, title, date, and phone number of the person completing the form. Ensure you provide a signature where required.
14. Once all sections are completed, you can save the changes, download, print, or share the form as needed.

Complete your General Liability Incident Report Form online today for accurate documentation!