Fillable Risk Identification and Evaluation (California State University, Los Angeles)

Fill Online, Printable, Fillable, Blank Risk Identification and Evaluation (California State University, Los Angeles) Form

Use Fill to complete blank online CALIFORNIA STATE UNIVERSITY, LOS ANGELES pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Risk Identification and Evaluation (California State University, Los Angeles)

On average this form takes 15 minutes to complete

The Risk Identification and Evaluation (California State University, Los Angeles) form is 3 pages long and contains:

  • 0 signatures
  • 7 check-boxes
  • 58 other fields

Country of origin: US
File type: PDF

U.S.A. forms for California State University, Los Angeles

BROWSE CALIFORNIA STATE UNIVERSITY, LOS ANGELES FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Risk Identification and Evaluation
The campus must determine if the activity or risk is one that may warrant departure from the regular insurance
requirements. The following information must be provided:
E
vent/Activity/Contract:
Date(s): Start/End Time:
Location:
Contract/Agreement Amount:
Description of Event/Activity/Contract:
Please answer all of the following questions (indicate N/A for those not applicable).
1. What activities will take place?
2. How many attendees are expected?
3. W
ho could be harmed? Will the public be involved? Will minors be present?
4. What property could be damaged and to what degree?
College/Division:
Telephone/Ext.:
Department:
Department Contact Information:
Name/Title:
Email Address:
Print
Clear
Event/Activity/Contract: _________________________________________________
2
5. Are crowds or bystanders/passersby likely to be involved?
No: _____
Yes/Possibly, please explain:
6. Will inherently dangerous activities be involved?
No: _____
Yes, please explain:
7. Will alcohol be served?
Yes No
8. Is there a possible pollution (air, soil, water) exposure?
No: _____
Yes/Possibly, please explain:
9. How likely is it that the University will be a defendant in the event of a loss?
10. Is there a reputational risk to the University?
No: _____
Yes, please explain:
11. Is this a recurring (annual) special event? If “yes” what is the safety/loss history of the event?
No: _____
Yes:
Department Administrator Comments:
Name/Title Signature/Date
Print
Clear
Event/Activity/Contract: _________________________________________________
3
Evaluator Comments:
What is the maximum likely loss for this activity?
Name/Title Signature/Date
Director, Risk Management/Environmental Health and Safety Comments:
Name/Title Signature/Date
*Vice President for Administration and Finance and CFO, or designee, Comments:
Name/Title Signature/Date
* Certain cases may require approval by the Vice President for Administration and CFO, or designee, (to be determined on a case-by-case basis).
Print
Clear
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Risk Identification and Evaluation (California State University, Los Angeles)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 22 July 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document