Please Note:
Completion of this form does not guarantee payment of the insurance claim.
Any payment is subject to the acceptance of the claim by the insurer under the terms of theinsurance policy.Depending on the value of the claim the insurer may appoint an assessor to inspect the claimsite. To facilitate this possibility all incidents should be reported promptly using the
Incident/Injury Report even if it is not yet clear whether there has been any loss.
The parish should not attempt to clean up the site or start any repairs before the police havecompleted their investigation (if appropriate), the assessor has completed their inspection andthe insurer has approved for work to commence. The one exception are essential works tomake the site safe and/or secure. In this case please ensure that photos are taken of the sitebefore works are commenced and these are retained for the insurer.