Tort Reform Instructions
Instructions for Completing a Standard Tort Claim Form
- Please type or print clearly in ink.
- Provide all requested information and any available documents or evidence supporting your claim, such as medical records or bills, photographs, or receipts for property damage.
- If the requested information cannot be supplied in the space provided, please use additional pages so your claim form can be easily read and understood.
- The following are examples on how to complete the Standard Tort Claim Form:
- Doe, Jane Ann
- 1234 18th Ave. S., Apt. 123, Lake Tapps, WA 98391
- PO Box 123, Lake Tapps, WA 98391
- Same (or residence at the time of incident)
- email@example.com or not applicable
- August 9, 2010 8:00 a.m.
- If the incident that caused the damages occurred over a period of time, please provide the beginning time and the ending time in item 8.
- Washington, Pierce County, Lake Tapps, name of school or site, room or space(i.e. :Gym)
- 178th, specify milepost if known, intersection of 178th and 16th
- Dieringer School District
- Smith, John 1234 Campus Parkway, Apt. 123, Lake Tapps, WA 98391 (253)123-4567
- List all names and titles if known
- List all other witnesses having knowledge of the incident in question, with their names, addresses and telephone numbers that are not listed within items 12 and 13. Also, include a description of their knowledge. For example, if your sister was with you, when the alleged incident occurred, please include her name, address, telephone number and indicate she witnessed the incident.
- Please describe the incident that resulted in the injury or damages, specifically answering the questions who, what, where, when and why.
- If you or others reported this incident to law enforcement or Security personnel, please provide a copy of the report or contact information.
- Please provide all of your medical providers with their names, addresses and telephone numbers if applicable. You will be asked to provide a medical release statement.
- Sign the Standard Tort claim form and date
Present in Person or Mail the Standard Tort Claim Form and Supporting Documents to:
Dieringer School District
Attn: Office of the Superintendent
1320 178th Ave E
Lake Tapps, WA 98391
Business Hours: Monday through Friday 8:00 a.m. to 4:30 p.m.
Closed on weekends and holidays.