As soon as possible call:  

The Archdiocese of Cincinnati

Claim Reporting Number:   833-273-5479

Click on the title below to download the specific form:

1.Performance Purchase Agreement

Click on the title below to download the specific form:

1. Child - Permission Slip
2. Adult - Permission Release, and Authorization to Seek Medical Treatment Form

Click here to download/print a copy of the 2023-2024 Safety Awareness/Risk Analysis form.

Click on this link to download/print an Accident Report form.

In addition to having policies, procedures and training on the prevention of slip, trip and fall accidents, it is also important to be prepared to respond to these incidents. Development of a formal policy and conducting training on how to respond to a slip, trip and fall accident will go a long way in providing immediate assistance to the injured person and reducing claims costs and the possibility of potential legal recourse.

1.      Offer assistance

Determine if the person is injured or requires medical attention. Call 911 if needed. Do not make statements about cause, responsibility or blame, and do not make promises about payment for medical bills.

2.      Document the slip and fall incident

It’s a good idea to document the details of the incident in case you need them later, even if the person doesn’t appear injured. For a nonemployee, record the person’s full name, address and contact information. If possible, immediately inspect the area with the affected person to determine the location and identify possible causes. Create a written account of facts, take photos and, if available, find video surveillance footage. Document the type and condition of footwear worn by the affected person.

3.      Report the slip and fall incident

Report the loss by calling 833.273.5479 as soon as possible. If the affected person is an employee, follow your standard workers’ compensation procedures, including a first report of injury form.

4.      Investigate the slip and fall accident

Look for the root cause.

1. • Physical hazards or unsafe conditions—Physical or environmental factors that contribute to a slip or fall, such as a leaky roof that causes water to pool on the floor or a patch of black ice in the parking lot.

   • Human behaviors or unsafe acts—Poor decisions that may contribute to an accident. Examples include not cleaning up a spill, not straightening a buckled floor mat or texting while walking.

Avoid placing blame on the employee or affected person, and don’t automatically jump to the conclusion that the accident was caused by unsafe behavior. Most importantly, your accident investigation process should include corrective actions to reduce the potential for future accidents.  (Source: BPIC, Spring 2023)