General Liability Accident Reports

General Liability Accident Report Form
for use by CFSA pool-member fairs only


Please email or fax your Accident Reports to CFSA as soon as possible.

To access CFSA’s Accident and Loss Report form from the link above, you’ll need Acrobat Reader. If you don’t have the latest version of Acrobat Reader, you can download it for free from the Adobe website.  This form can be filled in, saved, printed and emailed to CFSA, providing that the form is compatible with your browser. We highly recommend using Chrome or Internet Explorer. This form is to be completed by CFSA pool member fairs only. If you are a law firm representing a client, please contact Eugene Chang, or (916) 263-6171 to discuss the incident.

When you’ve finished filling out the form and you’re satisfied with the information you’ve provided, save it to your computer as a PDF. You can email it to Mark Stone, our General Liability claims manager, at through Acrobat Reader or Adobe Acrobat.
1. From Acrobat Reader/Adobe Acrobat: After you have filled in the online form, save it. To print, select the three vertical dots in the upper right hand corner of your  screen. This will open a drop down menu with a print option. To share (email) the form with CFSA, select the arrow icon in the top menu directly to the left of the three vertical dots.

If you prefer, you may also print out the form and fax to Eugene Chang’s attention. His fax number is: (916) 263-6159. The sooner you can get your accident report to CFSA, the better!

You’ll also find a copy of the Accident Report form in your fair’s Red Book (Claims and Loss Reporting Guide) under General Liability, Tab 2, that you can print out and use.

Why is it important for CFSA General Liability Pool members to fill out an Accident Report?
Reporting losses promptly to CFSA is essential to efficient claims handling. It’s not uncommon for the involved party to call us, so the sooner we hear about an incident, the better we can help everyone involved.

Resist the temptation to batch several reports together until the end of your fair. We know everyone’s busy during fairtime, but even short delays can prove costly to you, your fellow pool members, and to us as evidence and witnesses may become hard to locate. In addition, claimants may become more and more upset as time goes on. In fact, studies show that when claimants feel listened to and cared about, claims costs can be lower.

Report Serious Injuries Immediately
Serious injuries should be reported ASAP by phone to CFSA’s Executive Director Rebecca Desmond (916) 263-6161, so an investigation can be launched immediately. After normal business hours, please call (916) 921-2213 for further instructions.

We recommend that you take a few photos with a camera or cellphone to document the accident scene. Hand drawn diagrams with measurements are valuable too. The more information you can provide us with, the better for all involved.