The Oregon Tort Claim form is an essential document for individuals seeking to file a claim against a state agency due to damages or injuries incurred as a result of the agency's actions or negligence. This form requires claimants to provide detailed information about themselves, including their name, contact information, and the specifics of the incident that led to the claim. Key aspects of the form include sections for describing the incident, the date and location where it occurred, and any witnesses involved. Additionally, claimants must indicate whether a police report was filed and provide the relevant details if applicable. The form also contains a bodily injury questionnaire, which collects vital information regarding any injuries sustained, medical treatments sought, and associated costs. It is important to note that the claim must be submitted within 180 days of the incident, as stipulated by Oregon law. For those filling out the form, assistance is available through the Risk Management office, which can be contacted via phone or email. Completing this form accurately and promptly is crucial for ensuring that claims are processed efficiently.