Aircraft Information

This form is to be completed by University faculty/staff before using personally owned or leased aircraft while on University business.

Aircraft Release of Liability: Private Aircraft Travel

This form is to be completed by all individuals (pilots and passengers) before traveling in a personally owned or leased aircraft while on University business.

Federal Credit Reporting Act (FCRA): A Summary of Your Rights

Under the Fair Credit Reporting Act (FCRA) specific rights are outlined.

Student Vehicle Use Authorization

Student Vehicle use is limited to specific purposes and guidelines. Please carefully read the guidelines. If your situation meets all criteria complete this form and submit it along with the driving review request in the Driver’s License Review System.

University Driving Policy — Adverse Action-Denial of Employment Non-Compliant Iowa Driving Record (MS Word doc format)

This sample letter should be used by departments when denying an applicant employment with The University of Iowa due to their Iowa driving record not complying with The University’s Driving Policy.

University Driving Policy — Adverse Action–Denial of Employment Non-Compliant Out-of-State Driving Record (MS Word doc format)

This sample letter should be used by departments when denying an applicant employment with The University of Iowa due to their out-of-state driving record not complying with The University’s Driving Policy.

Incident Information Form (fillable pdf)

All incidents affecting members of the general public, students or others while on campus which you believe could reasonably result in a liability claim against the University should be reported to the Risk Management, Insurance & Loss Prevention Department (not used for University Hospitals and Clinics, auto accidents or workers compensation).

Property Loss Report Form (fillable pdf) 

Loss by theft or other unavoidable cause should be reported immediately to the Department of Public Safety (319) 335-5022. Use this form to report a loss or damage to University of Iowa property. The University seeks reimbursement of loss from the State of Iowa pursuant to Iowa Code Chapter 29C.20 or through the Property Reserve Claim Program. A departmental deductible will normally apply in the latter case. Please forward the completed form to Risk Management, Insurance & Loss Prevention, 430 Plaza Centre One, Iowa City, IA 52242. Contact the Department of Risk Management, Insurance and Loss Prevention at (319) 335-0010 for questions or assistance.

Request for Equipment Allocation Form (FREC) (fillable pdf)

This form is used for losses covered under the Equipment Loss Program (FREC). Departments may seek reimbursement for equipment losses from theft or other unavoidable causes through the FREC Equipment Loss Fund, administered by Risk Management. A $500 departmental deductible will normally apply. Contact the Department of Risk Management, Insurance and Loss Prevention at (319) 335-0010 for information prior to submission of a FREC claim.

State Appeal Board Claim Form and Affidavit 

The University of Iowa is a unit of the State of Iowa and as such, liability claims are covered in accordance with Chapter 669, Code of Iowa. Chapter 669 allows tort claims against the State of Iowa for property damage, personal injury, or wrongful death resulting from negligence of the State or its employees while acting in the scope of the employee’s office or employment. 

You may file a tort claim by submitting the State Appeal Board Claim Form and Affidavit to the State Appeal Board. For more information about the tort claim process, instructions for submission of a claim, and the forms required to file a claim you may visit https://dom.iowa.gov/faq/what-process-tort-claims.  Forms are completed in triplicate, signed, notarized and mailed to the State Appeal Board.

Vehicle Accident Report Iowa Regents Institution

Within 48 hours of a motor vehicle accident, complete this form. Accidents involving injury or death must be reported immediately to the nearest law enforcement agency.

Vehicle Appeal Board Form  

The University Driving Policy requires periodic screening of driving records or self-certification forms to be completed to determine driving eligibility for conducting University business. Should you be denied the privilege of driving on behalf of the University, you may choose to appeal the decision.

Appeal Process: If you feel there are special circumstances involved you may appeal your non-compliance to the Vehicle Appeal Board. Please forward the form to Risk Management, Insurance & Loss Prevention at 430 Plaza Centre One or driving-safety@uiowa.edu.

Volunteer Authorization Form 

You are a volunteer if you provide services to, or on behalf of, the University and have no legal duty to do so, have no personal interest or gain from the activity, and receive no compensation or consideration (except expense reimbursement) for the services you provide.