MO Project: Contextual Branding

Reporting General Liability Accidents

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TO:  Missouri State Agencies

FROM:  Blake Grosvenor, Risk Management Specialist

RE:  Reporting General Liability Accidents

This memo is in regard to submitting an Accident on State Property form (M0300-0167). This form is used for visitors (not state employees) who are injured on state property.

Risk Management is available to state agencies to assist with the accidents. It is the responsibility of the agency to complete the form and obtain all needed information including name and address of the party involved. If this information is not available to Risk Management, this delays the processing of the claims. This form should not be completed by the claimant.

Risk Management should be notified by phone of all accidents within 24 hours. The Loss Notice should be completed in full and forwarded to our office in two to three days.

Please do not accept any liability, or state that any payment will be made, only Risk Management has this authority.

If you have any questions, please do not hesitate to contact our office at (573) 751-4044.

In Case of Accident Brochure