Resources
CCFR TORT CLAIM FORM
INSTRUCTIONS FOR COMPLETING A STANDARD TORT CLAIM FORM
- Before presenting a Standard Tort Claim form, please read these instructions, the Standard Tort Claim form, and other appropriate forms in their entirety.
- Type or print clearly in ink and sign the Standard Tort Claim form.
- Provide all requested information and any available documents or evidence supporting your claim, such as medical records or bills for personal injuries, photographs, proof of ownership for property damages, receipts for property value, etc.
- If the requested information cannot be supplied in the space provided, please use additional blank sheets so your Standard Tort Claim form can be easily read and understood.
- The following are examples on how to complete the Standard Tort Claim Form:
- Smith, Karen Michelle
- 1234 College Way, Apt. 56, Vancouver, WA 98661
- PO Box 910, Vancouver, WA 98666
- Same (or residence at the time of incident)
- 360-123-4567
- john.doe@comcast.net
- 8:00 a.m., August 9, 2008
- If the incident that caused the damages occurred over a period of time, please provide the beginning time and the ending time in item 7
- Campus of Clark Community College, Building number 22, 123 4th Street Vancouver, WA 98661
- SR 502, 72nd Avenue
- List all persons involved in or witness to the incident in question, with their names, addresses, and telephone numbers. Also include a description of their knowledge. For example, if your sister was with you, when the alleged incident occurred, please include her name, address, telephone number, and indicate she witnessed the incident.
- Provide all of your medical providers with their names, address, telephone numbers, and the type of treatment. If you were treated for a personal injury, please include your medical records and bills.
- Describe the incident that resulted in the injury or damages, specifically answering the questions who, what, where, when, and why.
- If you reported this incident to law enforcement, safety, or security personnel, please provide a copy of the report or contact information to the person you spoke with.
- List all other individuals not described in numbers 11 through 14 that have knowledge of the incident. Include their names, addresses, telephone numbers, and a description of their knowledge.
- Attach all documents which support the claim’s allegations.
- Provide the dollar amount for your damages, including your time loss, medical costs, property damage loss, etc. This amount should represent your opinion of total compensation.
- If you are presenting a personal injury claim, please sign and attach the Medical Release form.
- If your claim involves a motor vehicle accident, please complete, sign, and attach the Vehicle Collision form.