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Attachment A – Quarterly Report

To: Vice President for Administration and Finance

From: SSU Risk Manager

Subject: Quarterly Risk Management Report

Period Ending: Month ______ Year______

As required by the Sonoma State University Risk Management Policy, the following quarterly report is submitted for your review and action as necessary. Please do not hesitate to contact me for clarification or additional information.

Workers’ Compensation

  1. Claims Outstanding Previous Period: ____________
  2. Total Dollar Value Reserved Previous Period: $ _________
  3. Adjustments to Previous Claims’ Reserve this Period $_________
  4. Claims Closed this Period: ____________
  5. Value of Claims Closed this Period: $______________
  6. Claims Opened this Period: ____________
  7. Value Reserved for New Claims this Period: $ _________
  8. Total Outstanding Claims____________
  9. Total Dollar Reserve of Outstanding Claims $ _________

Significant Workers’ Compensations Issues Outstanding this Period.

Liability Claims

  1. Claims Outstanding Previous Period: ____________
  2. Total Dollar Value Reserved Previous Period: $ _________
  3. Adjustments to Previous Claims’ Reserve this Period $ _________
  4. Claims Closed this Period: ____________
  5. Value of Claims Closed this Period: $ _________
  6. Claims Opened this Period: ____________
  7. Value Reserved for New Claims this Period: $ _________
  8. Total Outstanding Claims ____________
  9. Total Dollar Reserve of Outstanding Claims $ _________

Significant Liability Claim Issues Outstanding this Period.