The "Report of Significant" Incident form was designed to help reduce the cost of claims. Members should use the form to provide the C JPIA with immediate notice of a significant incident so that we can begin immediate investigation. This form should be completed and returned as quickly as possible, regardless of whether claims have been filed.

The information which can be gathered while the scene is still fresh can be invaluable in preparing the defense of possible claims. It is much easier to locate witnesses immediately after the incident rather than up to six months later when a claim may be filed. Prompt reporting is more important than having completed all of the requested information.

Do not delay reporting while awaiting a piece of information. Please complete the form below and click submit. If you would like to distribute a hard copy of this form to your operating departments, simply open the form using Adobe Acrobat.

If you have any questions or need further assistance, please call our offices at (562) 467-8700.

In the unfortunate event that a significant incident occurs, please be assured that we will do everything possible to reduce the losses to your agency and the pool.
These are PDF files, so you will need Acrobat Reader 4.0 (or later) to read them. If you do not have this program downloaded on your computer, you may download it free of charge from Adobe's website.

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