Liability Claims

Reporting General Liability Claims Guide

Account Information

  • Provide Company Information if applicable

Product Liability

  • Provide location of your Company Headquarters

Slip and Fall or Other Liability

  • Provide location where accident occurred

All Liability Claims

  • Your Business name & address (include specific division if applicable and mailing address if different than above. 
  • Specifics e.g. aisle of fall, Dept.

Accident Information

  • Date & time of accident
  • Detailed description of accident

Product Liability

Product Information

  • how was product being used
  • specify manufacturer's name
  • make/model/size/style/serial # and/or product I.D.
  • was there damage to product
  • where & when purchased
  • where & when can product be seen


Slip and Fall

  • What substance or object did claimant slip/trip or fall on (if any)
  • How did substance or object get there

All Liability

  • Witnesses including specifics on where they were at time of accident, any relationship to involved parties and means of contact (address, phone #, best time & place)
  • Authorities (ambulance, police, fire) include address, report # and any violations/citations that may have been issued
  • Nature of Occurrence Were there complaints of injuries (any special treatment)?
  • Was there any damage to property you don't own?
    • If yes, refer to info needed in "property damage" section


  • Name, address, home & business phone for injured
  • Occupation (if provided)
  • Date of birth (age) Social Security # & sex
  • Description of injury
  • Was medical treatment received? If so, from who
  • Name, address, phone # of hospital/clinic/doctor
  • Type of treatment, length of stay, specialty of doctor
  • First day of treatment
  • Is injured represented by an attorney?
    • Name, address & phone number
    • Was lawsuit served? If yes, date of service
  • Employer Information (Name, address & phone) (If multiple injuries, repeat above section)

Property Damage Information

  • Property owner's name, address, home and business phone
  • Description of damage (include both description of item and damage to that item)
  • Estimate of damage, if available (If other property damage, repeat above section)

Account Contact Information

  • Best person (including time & place) to contact for more information
  • Additional comments and information

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Executive Sales

GS Security Systems, Inc.