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Get Ga Doas/rms Gl Report Form 2010-2026

STATE OF GEORGIA General Liability Incident Report Form If a non-state employee is injured or property of others is damaged or alleged as a result of the State s operations whether negligent or not report the claim directly to DOAS / Risk Management Services by calling 404-656-3237 or Email to risk. management doas. ga.gov or Fax to 404-657-1188. Keep your answers brief and to the point. Do not use this form for Auto Liability Claims Time is of the essence. Accident Information - General Liability State Agency involved Date of the incident Incident time Incident location City and County Description of the incident Police authorities contacted If yes Accident Report Number Claimant Information Name address of the Claimant Home Telephone No. Work Telephone No. Injured party date of birth Social Security No. Injury Information Brief description of the claimant s injury Fatality Yes What initial treatment was given Was hospital treatment needed No By whom Which hospital Witness Information....

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How to fill out the GA DOAS/RMS GL Report Form online

Filing the GA DOAS/RMS GL Report Form online is essential for reporting incidents involving non-state employees who incur injuries or property damage related to State operations. This guide provides clear instructions to help you complete the form accurately and efficiently.

Follow the steps to fill out the GA DOAS/RMS GL Report Form online.

  1. Click the ‘Get Form’ button to access the form and open it in your preferred online editor.
  2. Begin by filling in the Accident Information section. Here, specify the State Agency involved in the incident, along with the date, time, and location of the incident, including the city and county.
  3. Provide a brief description of the incident. Indicate whether police authorities were contacted and include the Accident Report Number if applicable.
  4. In the Claimant Information section, enter the name and address of the claimant. Include home and work telephone numbers, the injured party's date of birth, and their Social Security Number.
  5. Detail the Injury Information by providing a brief description of the claimant’s injury. Indicate if there was a fatality, what initial treatment was given, and whether hospital treatment was needed. If applicable, specify the name of the person who provided treatment and which hospital was involved.
  6. For any Witness Information, state whether there were witnesses to the incident. If there were, include their names, addresses, and phone numbers.
  7. Complete the Property Damage to Others Information section by describing the claimant’s property involved and its current location. Provide details about the damage to the claimant’s property and include a repair estimate.
  8. Add any additional comments you feel necessary at the end of the form.
  9. Finally, fill in your name and phone number at the bottom of the form, review your entries for accuracy, and ensure all required field information is complete before submission.
  10. Once you have completed the form, save your changes. You can choose to download, print, or share the form as necessary.

Start filling out your documents online to ensure timely reporting and processing.

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STATE OF GEORGIA General Liability Incident Report...
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