Risk Management
PAEC Documents and Forms
Authorization to Treat (requires notary)
Bloodborne Pathogens Exposure Incident Report
Builder's Risk Insurance Application Form
Certificate of Insurance
Contact Miranda Green with questions.
Field Trip Medical Release (Spanish)
Health Insurance Portability and Accountability Act (HIPPA) Form
Medical Release Form
Nomination Forms
PAEC Loss Notice Liability Form (Word)
PAEC Medical Form
PAEC Risk Management Advisory Committee Meeting Agenda
Personal Injury Protection (PIP) Notice
Pharmacy Authorization Form
Safety Manual
Safety Meeting and Training Certification Report
Schedule of Insurance Form
Sentry Student Accident Claim Form (2010-2011)
Student Accident Claim Form (2013-2014)
Student Accident Claim Form (2012-2013)
Student Accident Claim Form (2011-2012)
Student Accident Report
Walkway Accident Report Form
WC Mileage Reimbursement Form
WC Referral Form
Contact Frances Rogers with questions.

Many of the most commonly requested forms are now available online. These forms require the Adobe Acrobat Reader. Click here to download this software.


Risk Management

Project Director

Lele Brock - Program Coordinator
Phone: (850) 638-6131 ext 2263

Project Staff
Tony Ganstine - Business Operations and Safety Specialist
Phone: (850) 638-6131 ext 2330
Frances Rogers - Property and Casualty Secretary
Phone: (850) 638-6131 ext 2248
Phone: (850) 638-6131 ext 2303
Pam Carter - Group Health Secretary
Phone: (850) 638-6131 ext 2284

Project Services
Florida's first multi-district self-insured property and casualty program was formed at PAEC in 1981 by small school districts in north Florida to provide property and casualty insurance to participating school districts. The program broadens the protection afforded by standard insurance policies and so includes types of coverage not previously carried by districts. By combining into a consortium, the small school districts are able to benefit from increased buying power and reduced costs for the coverages provided. In addition to insurance protection the consortium provides loss control services and "safety" programs to prevent losses from occurring.

The PAEC Risk Management Consortium is comprised of the following school districts:

District Superintendent Risk Manager
Calhoun Ralph Yoder Suzanne Mason
Franklin Nina Marks Al London
Gulf Jim Norton Duane Mcfarland
Holmes Eddie Dixon Larry Zorn
Jackson Steve Benton Stuart Wiggins, Beverly Jackson
Jefferson Al Cooksey Robert Lloyd
Liberty Gloria Uzzel Rusty Hill
Madison Doug Brown Andy Barnes
Wakulla Bobby Pearce Karen Wells
Walton Carlene Anderson Sonya Alford
Washington Joe Taylor Mike Park

Advisory Committe Members
The PAEC Risk Management Advisory Committee (RMAC) provides guidance for the PAEC Risk Management program. The input of this committee is vital for providing services to our member schools and is comprised of district representatives appointed by each member superintendent.

The current PAEC Risk Management Advisory Committe (RMAC) membership is:

Suzanne Mason
Calhoun County School Board
20859 Central Avenue
Blountstown, FL 32424
(850) 674-8123, ext. 28 and
(850) 674-8943, ext. 28
(850) 674-5814 FAX
Al London
Franklin County School Board
85 School Road, Suite One
Eastpoint, FL 32328
(850) 670-2810
(850) 670-2811 FAX

Gulf County School Board
150 Middle School Road
Port St. Joe, FL 32456
(850) 229-8256
(850) 229-6089 FAX
Larry Zorn
Holmes County Office Complex
701 E. Pennsylvania Avenue
Bonifay, FL 32425
(850) 547-6674, ext. 234
(850) 547-3568 FAX
Stuart Wiggins, Beverly Jackson
Jackson County School Board
P.O. Box 5958
Marianna, FL 32447-5958
Beverly Jackson-(850) 482-1200,ext.214
(850) 482-1299 FAX
Robert Lloyd
Jefferson County School Board
1490 West Washington
Monticello, FL 32344
(850) 342-0100
(850) 342-0108 FAX
Rusty Hill
Liberty County School Board
P.O. Box 429
Bristol, FL 32321
(850) 643-2275, ext. 225
(850) 643-3010 FAX
Andy Barnes
Madison County School Board
210 N.E. Duval Street
Madison, FL 32340
(850) 973-5022
(850) 973-5027 FAX
Karen Wells
Wakulla County School Board
P.O. Box 100
Crawfordville, FL 32326-0100
(850) 926-0065
(850) 926-0123 FAX
Sonya Alford
(850) 892-1100 ext.1312
(850) 892-1190 FAX
Walton County School Board
145 Park Street
DeFuniak Springs, FL 32433
Mike Park
Washington County School Board
652 Third Street
Chipley, FL 32428
(850) 638-6222
(850) 638-6226 FAX