Sample Form


TO: All Agency Staff

FROM: ______________________ (E&O Loss Control Manager)

We recently experienced an E&O claim or a “near-miss” incident that can provide a valuable lesson for all of us concerning E&O loss control procedures.

What happened? (Describe in detail the circumstances leading to the incident and the outcome.)
What specific procedure in the Agency Procedures Manual, if any, was not followed that caused this claim or incident?
What procedure should be added to the Manual, or how should the existing procedure be changed or strengthened as a result of this incident?
Person responsible for follow up?
What can be done to prevent a similar incident in the future?