Claim Notification Form - Campus Safety

NOTE: This form should only be submitted for UNC-Chapel Hill property.

Prompt claim reporting is required. Please notify Risk Management using the form below within 24 hours of the loss.

Your Name:(Required)

First Last

Your Email Address:(Required)

Your Department:(Required)

Date of Loss:(Required)

Location Address:(Required)

Street Address Address Line 2 City State ZIP Code

Building Name:(Required)

Description of Loss:(Required)

Damage Estimate:(Required)

Please enter a number greater than or equal to 1.

Actions Taken to Remediate or Prevent Further Loss:(Required)

Remarks:(Required)

Pictures of Damages:(Required)

Drop files here or

Accepted file types: jpg, gif, png, pdf, doc, docx, Max. file size: 98 MB, Max. files: 10.