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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)
    • (253)123-4567
    • 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

Submitting Packets

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.