Forms

Loss Control Evaluation
Evaluation Form
Criteria

Loss Control Forms
Employee Road Test Check Ride
Job Site Inspections Report
Monthly Parks Safety Guidelines
New Driver Orientation Checklist
Public Facilities Monthly Inspection
Quarterly Non-Public Building Safety Inspection
Risk Management Recognition Award and Entry Form
Risk Management Grant Application

• Appendix D – Grant Program
• Ineligible Items

Sample Hold Harmless – Contractor
Sample Hold Harmless – Lease
Sample Hold Harmless – Parades & Festivals
Sample Hold Harmless – Use of Facilities
Sample Participant Waivers
Sample Vehicle Inspection Checklist
Vaccination Declination Form
Weekly Playground Inspection Checklist

Claims Forms
To file a claim, go to Origami’s website
Work Comp Wage Statement
Supervisor’s Investigation Report
Sewer Backup – Customer Information

Proof of Insurance

Vehicle Insurance Cards for Fleet  (for individual vehicles, print from Origami)

Certificate of Insurance Request Form

Police 
2024 Police Model Policy (Word document)

Background Check Form

Police Policies Test and Answers

Police Ride Alongs Whitepaper 2024

Human Resources
Sample Employment Application
MIRMA Model Personnel Policy (Revised 1/12/2023)

• Model Personnel Policy (Revised 1/12/2023 with changes in red)