Risk Management and Insurance Forms


 --Captain Kirk's View of Risk is Our Business

Risk Management and Insurance Forms and Uses                                                                             

The forms below are used for various Drake approved activities. The forms need to be completed and forwarded to the risk management contact, Donna Blunck.  The forms should be submitted in a timely manner to allow  ample time to review and run approvals (as necessary).

  Risk Management and Insurance Forms and Uses (Downloadable)

1.  Certificate of Insurance Request(COI). These forms are used to request certificates of insurance from vendors for Facility Rentals, Services <$25,000, Contracts, Events, Chartered Rentals, Sport Camps, etc.
Certificate of Insurance Request Forms:

2.  Field Trips.      Used for various events, such as, class trips, mock trials, moot court, workshops, debates, etc.
Field Trip Forms:

  • Key Contact fills out a Summary of Trip form: Trip  (this form is part of the Clery Act reporting requirements.) Trip Summary
  • Participants must fill out form:Release of Liability Waiver‌ (Adult and/or Minor)
  • Drivers fill out:  Motor Vehicle Request form: Motor Vehicle Request
    • Drivers Driving their Personal Vehicle fill form: Personal Vehicle Release
    • Drivers driving a  Rental Vehicle must fill out Motor Vehicle Request
    • Rental of a Bus and/or Driver must request a Certificate of Insurance from Bus Co. form: Bus/Limo‌ Certificate of Insurance Request Form

3.  International Trips.
     Used for those traveling on behalf of Drake to a foreign country.  MEDEX is part of the university’s group travel insurance. It provides travel assistance, medical evacuation, repatriation, etc.
MEDEX Roster Form: MEDEX Roster  and for the traveler’s use:Traveler Documents

4.  Incident or Accident Report.  
     Used for incidents that do not have a security incident report filed.  Use for slips, falls, thefts, vehicle accident, property damage.
Incident Form: Incident‌ (Accident Injury Incident Reporting Process); Vehicle Accident Report‌  form

NOTE: Faculty, staff, or student employee falls or injuries are workers comp related. Those injuries are to be reported through Blueview HR Forms portal.  Form is found under Employee Tab titled:  First Report of Injury.

5.  Insurance Card.       Used for vehicle rentals and Drake owned vehicles.
Insurance Card Form: Insurance Card

6.  Motor Vehicle Report (MVR).   Used for Drake Driver Approval—Process: a motor vehicle report is run.  All Drake approved drivers must have 6 or less mvr points based on the Motor Vehicle Points List. 
Driver Approval Forms:  Motor Vehicle Request‌ and Motor Vehicle Point System

7.  Release of Liability (ROL).       Used for various events--on campus, off campus, debates, field trips, mock trials, moot court, competitions, personal vehicle use, personal property on campus, etc.
ROL Form(s):






































University News
August 20, 2014
The Iowa Commission on Volunteer Service (ICVS) announced the selection of Courtney Howell as the August 2014 Iowa AmeriCorps Member of the Month.