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Capitol Corridor, Solano County
University of California
Capitol Corridor, Solano County

Insurance/Incident Report Forms

Use the Solano County 4-H Complaint Form to report all non-medical incidents that pose health & safety concerns or potential violations of California 4-H Member Code of Conduct, Adult Volunteer Code of Conduct, or Parent, Guardian, or Adult Participant Code of Conduct whether or not the individual is enrolled in the 4-H Program.

Use the Hartford Insurance Claim Form to report all injuries and medical incidents (both youth & adult). Bring a blank form with you on every 4-H outing or activity. If an injury occurs, immediately complete the claim form and call the UCCE office to report the incident.

Use the UC/ANR Incident Report Form to report all incidents, accidents or near miss involving ANR employees, volunteers, 4-H members, or property. The form is for either severe or minor incidents, property damage, theft, or other losses, including motor vehicle accidents. The form should also be used to report injuries to non-employees (i.e.: volunteers, youth members, visitors) participating in UC ANR activities or events.

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