Forms

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There are three different types of forms you can download from this site. To download a form you can click on the download icon below. 

If you have any questions regarding any of the forms, please contact Shannon Gunderman at (928) 373-1137 or e-mail shannon.gunderman@yumacountyaz.gov

Incident Report Form
Incident Report forms are to be used by County employees to report incidents leading to the loss or damage of County property or to report a situation which may result in a claim against the County.

Incident Report forms should not be used to file a claim against the County.

Incident Report Form [MS Word].

Supervisor's Report of Injury Form

The Supervisor's Report of Injury form is used by County employees to report workplace injuries. Completed forms should be forwarded to Risk Management for processing.

Supervisor's Report of Injury form [PDF].

Notice of Claim Form
All claims against Yuma County and/or its employees must conform to the requirements of Arizona law and be served upon the appropriate parties. Claim sufficiency is the responsibility of the claimant.

Notice of Claim Form [PDF].

Certificate of Insurance Form
Certificates of insurance provide individuals and companies contracting with the County evidence that the County is properly insured. To request a certificate of insurance, download and complete the Certificate of Insurance form and forward it to Shannon Gunderman at 145 S. 2nd Avenue, Yuma, Arizona 85364. Or you can email the completed form to shannon.gunderman@yumacountyaz.gov.

Certificate of Insurance Form [PDF].

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