American Specialty
American SpecialtyAmerican Specialty
Risk ManagerRisk Manager
U.S. Ski & Snowboard Incident Input
FIRST REPORT OF INCIDENT
* Denotes a Required Field

Event Organizers: Please complete all required fields to the best of your ability. A claim cannot be started without this information.
Please note that completing this form is not a guarantee of coverage.


Coverage Underwritten By:
Mutual of Omaha Insurance Company
Mutual of Omaha Plaza
Omaha, NE 68175

Basic Information
Injured Person Information
Event Details
Incident Location
Injury Information
Witness Information
Employer and Address Information
Guardian/Parent (If Injured Person is a Minor)
Information Regarding the Individual Completing This Form