University of Central Florida Coverage Forms

New Hire/Volunteer Notification

New hires and volunteers delivering healthcare services under the following license types, with the exception of those with training licenses, are required to complete and submit a Professional Liability Questionnaire (PLQ): MD, DO, DMD, DPM, PhD, PsyD and PharmD

• Employee
• Volunteer

New healthcare providers that do not require a PLQ (as described above) and hospital employees requiring credentialing need to have a New Hire Notification form submitted on their behalf. This form is only to be completed and submitted by a clinical unit’s designated HR Representative, Division Administrator, Chair, Dean or their designated delegates.

• New Hire Notification

Community Service

• Community Service Activity: PL Coverage Request

Extra-Curricular Student Activity

• Extra-Curricular Student Activity (ECSA) Approval Form

Visiting Student

• Professional Liability Insurance Verification for Visiting Students

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