Supervisor’s Incident Investigation Report

GLOUCESTER COUNTY INSURANCE COMMISSION
SUPERVISOR’S INCIDENT INVESTIGATION REPORT

Please complete this form and submit to the entity’s claims coordinator within three (3) business days of incident. Do not delay submitting report! Police reports, estimates, and any supporting documentation can be submitted separately.

Instructions for Supervisor:  Please complete this form to the best of your ability. You will be able to save the form at anytime to complete at a later time by clicking the “save and continue later” button at the bottom.  IMPORTANT: Please follow instructions to email the form link.

Printable Blank Forms:  Click here to download a blank printable form.

Choose Entity to Complete Online Report:

Gloucester County  |  College  |  GCIA  |  GCUA GCLC