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Tort Claim Form
Handle: Document-84292
Owner: Carrell, Janea (User-136, 05492:EVERETT)DS
Wednesday, November 9, 2016 08:27:56 AM PST
Friday, October 28, 2022 08:47:27 AM PDT
Modified By: Diaz, Ailienette (User-392, 08810:EVERETT)DS
Locked By:
  • STANDARD TORT CLAIM FORM
General Liability Claim FormPursuant to Chapter 4.92 RCW, this form is for filing a tort claim against theEverett Public Schools.
  • School or department alleged responsible for damage/injury:
12.
  • Attach additional sheets if
necessary.
  • 15.
  • Describe the cause of the injury or damages.
  • Attach copies of all medical reports and billings.
18.
Allowed
Debbie Montgomery
Adobe Portable Document Format (.pdf) - application/pdf
Standard Tort Claim Form.pdf
No
4
91379
No
Appears In: Risk Management
Preferred Version: Tort Claim Form