Small Claims Incident Report

Members of the UB community can file a small claims incident report arising from alleged negligence on the part of the University at New York. This "small claim" cannot recover damages in excess of $5,000.00 and does not include damages because of the actions of students, independent contractors or consultants.

- Claims must be filed within ninety (90) days of the alleged incident.

- The university does not reimburse for costs related to vehicle rental. The claimant must submit these charges to the personal insurance carrier.

Instructions

Please be advised that the liability must be shown to be directly caused by the act or omission on the part of a state officer or employee as described in the claim. Damage caused by “an act of God” or other accidental occurrence which is not caused by the negligence or breach of duty by a state officer or employee is not the State University’s responsibility. The individual causing the damage must be an officer or employee of the State of New York, not an independent contractor, for the State University to be liable.

The State is not automatically responsible for bills (medical, repairs or other) simply because the incident occurs on its premises or as a result of its operations. It is your responsibility to fulfill your financial obligations. 

If your claim meets the above requirements, then:

  1. Complete the Incident Report
    1.  Include additional supporting documentation (e.g., police reports, photographs, charts, maps, diagrams) 
    2. Write your full name, incident date, item description and location of incident on reverse side of attachments
    3. Include a minimum of 2 estimates for vehicle damages
    4. Clearly explain the incident and why you believe the university is responsible
  2. Send it immediately to: 

        EH&S Small Claims Administrator
        220 Winspear Avenue
        Buffalo, NY 14215

or fax to: 716-829-2704

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Completing the PDF Form

  1. Read through all pages of the document to find specific instructions if any
  2. Enter requested information into the form
  3. Print the form
  4. Get required signatures
  5. Scan a copy of the signed form for your records
  6. Send the original, completed, signed form to:         

Enviornment, Health & Safety
220 Winpsear Ave
South Campus

ehs@facilities.buffalo.edu

Need Help Completing the Form?

Send email, phone or submit a question

EHS avatar

Environment Health & Safety

Service Building, 220 Winspear Ave.

Phone: 716-829-3301

Email: ehs@facilities.buffalo.edu

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Form Facts

Form Type: Downloadable, PDF document

Requirements: Adobe Reader

Owner: Environment, Health & Safety