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Forms Property & Liability Forms DOT Driver Update Form Insurance Requirements in Contracts (PDF) Insurance Requirements in Contracts (Word Doc) Participation Hold Harmless Agreement Special Events Application Claim Forms General Liability Claim & Incident Reporting Guidelines District Instructions for Liability Claims Accident Report Form Claim for Injury/Damage Claim for Injury/Damage-Spanish Version Property Claim & Incident Reporting Guidelines District Instructions for Property Claims Vehicle Accidents District Instructions for Vehicle Accidents Auto Accident Description Auto Accident Diagram Workers Compensation Forms OSHA Reporting Requirements CRSIG Designated Physicians & Clinics Pre-Designation Forms CRSIG Pegasus Claim Reporting Checklist Supervisor Report of Injury 60 Day Industrial Leave Worksheet (Excel) Charter School Forms Charter School Annual Questionnaire Charter School Application Packet Vision Forms Declination of Coverage Form Vision Enrollment/Change Form Dental Forms Declination of Coverage Form Dental Enrollment/Change Form Dental Billing Change Request Form HIPPA Authorization Risk Management Forms Athletic Permission & Hold Harmless Facility Use by Other Member Field Trip Emergency Plan Field Trip Evaluation Approval Form Field Trip & Excursion Permission Form Gym-Employee Use of Gymnasium Gym-Open Gym Permission and Hold Harmless-Student Gym-Public Member Use of Gymnasium Gym-Use of Gymnasium Sign-In & Sign-Out Log Hold Harmless & Indemnification Agreement Medication Assistance Authorizations Mutual Hold Harmless Non-District Provided Transportation Non-District Provided Transportation: Use of Private Vehicle Special Events Insurance Application Volunteer Personal Automobile Use Form Volunteer Registration Workout Room-Employee Workout Room Sign-In & Sign-Out Log Workout Room-Use of Workout Room by Employees

Next Workers' Compensation Next WHO WE ARE The Central Region School Insurance Group (CRSIG) is a Joint Powers Authority formed out of the California Government Code which allow public agencies to jointly maintain and operate an agency that serves a common purpose. CRSIG was formed in 1980 to establish programs for the insurance and risk management of school operations. Central Region School Insurance Group remains successfully focused on providing stellar management of the risks associated with the provision public education to the children of our community. CRSIG offers Property & Liability, Workers’ Compensation, and Vision and Dental benefits for school employees. Some of the programs are self-insured while others are fully-insured or a combination of both. Our office is located in the California Central Valley in the city of Modesto. We serve school district members in Stanislaus and Merced counties. Property & Liability Program Next Vision Program Next Dental Program CONTACT Contact Us Central Region School Insurance Group 1120 Tully Road Modesto, CA 95350 Phone:(209) 579-7535 Fax:(209) 579-7530 Hours of Operations Monday - Friday 8:00 a.m. - 4:30 p.m. Closed Saturday and Sunday Angela Jacobson, ARM Executive Director 209-985-2650 angela@crsig.com Josh Martinez Return to Work Specialist 209-531-3181 209-579-5288 (Fax) josh@crsig.com Lillian Parnoutsoukian Finance & Operations Specialist 209-985-1290 lillian@crsig.com Alondra Gonzalez Administrative Assistant 209-985-1180 alondra@crsig.com

CRSIG provides first party physical property damage coverage for our member districts. CRSIG is self-insured for the first $100,000 of each loss. Members have a deductible based on Average Daily Attendance (ADA). CRSIG is a member of PRISM for excess limits of coverage. We also provide comprehensive legal liability and automobile liability coverage for member districts, as well as coverage for physical damage involving collision and comprehensive incidents to member district vehicles. CRSIG is self-insured for the first $250,000 per occurrence and Members have a deductible based on Average Daily Attendance (ADA). Learn more For Property & Liability forms please click here.

The Central Region School Insurance Group offers a self-insured vision program through Vision Service Plan. Members choose their plan benefit and deductible options from the three plans and multiple deductible options available. For Vision forms please click here.

CRSIG JOB ANALYSIS FORMS Behavioral Support Aide Campus Supervisor Custodian Custodian II Custodian/Grounds I Custodian/Grounds II Head Custodian Food Service Coordinator Food Service Cashier Food Service Worker Supervisor of Building & Grounds Grounds Maintenance Worker Instructional Assistant Intervention Aide Library Media Technician Maintenance Technician Lead Maintenance Technician Office Manager-Elementary School Paraprofessional for Student Support Program Assistant Resource Specialist Program Aide Teacher (Primary) Teacher (Middle School) Teacher (Special Education)

Governance Meetings and Agendas Next Meeting Executive Committee Meeting - March 16, 2026 Register Meeting Schedule Executive Committee Meeting - April 20, 2026 Board of Directors Meeting - May 18, 2026 Executive Committee Meeting - June 15, 2026 Note: All meetings begin at 2:00 p.m. at the CRSIG Office unless otherwise posted. For the full agenda, click here. Agendas March 16, 2026 January 12, 2026 Strategic Planning Agenda October 20, 2025 September 15, 2025 Officers and Executive Committee Officers President Andreya Viscovich Empire Union School District Treasurer-Auditor Julie Betschart Stanislaus County Office of Education Vice-President Helio Brasil Keyes Unified School District Secretary Angela Jacobson, ARM Central Region School Insurance Group Executive Committee Andreya Viscovich Helio Brasil Julie Betschart Shannon Sanford Brenda Smith David Viss Kassandra Booth Terry Metzger Jose Aldaco Empire Union School District Keyes Union School District Stanislaus County Office of Education Stanislaus Union School District Hughson Unified School District Ceres Unified School District Oakdale Joint Unified School District Denair Unified School District Waterford Unified School District Representative Representative Representative Representative Representative Representative Representative Alternate Alternate

RISK MANAGEMENT GUIDELINES July 2025 1) Risk Management Guidelines: AEDs (Automated Electrical Defibrillators) Alcoholic Beverages at Educational Facilities Carnival Activity Events Field Trip Guidelines: Field Trips …(Table of Contents) Field Trip Review & Approval Field Trip Excursions Recommended & Discouraged by CRSIG Risk Management Guidelines for CRSIG Recommended Trips & Excursions: Amusement Parks Climbing Walls Deep Sea Fishing Excursions Downhill Skiing or Snowboarding Exploration of Abandoned Mines Fishing From a Boat in a Lake Go-Karts Hiking Excursions Ice Skating in Commercial Rinks Out of State and Overnight Parades and Student Participation Ropes or Challenge Courses Sailing Vessels Anchored - In a Bay or Lake Science Based Tide Pool/Shoreline Excursions Swimming Activities Whale Watching Sample Forms: Sample Form & Tips Field Trip Approval Form Field Trip Emergency Plan Graduation Celebration Committees Helicopter Landings at Schools Homecoming Activities Live Animals Medications & SHARPS Disposal Open Gyms Parades On & Off School Sites Personal Items, Appliances & Furniture Playground Supervision Risk Levels/Liability Limits/Prohibited Events School Operated Swimming Pools School Site Activities (End of Yr., Fundraising, etc.) Student Transportation Use of Dry Ice Volunteers Workout Room – Use By Employees 2) Risk Management Forms: Accident Report Alcoholic Beverages at Educational Facilities Sample Policy Athletic Permission and Hold Harmless Field Trip & Excursion Parent Permission, Immunity Release, Med. Tx Hold Harmless Language Samples: Hold Harmless & Indemnification Agreement Mutual Hold Harmless – Schools Special Events Insurance Application: (HUB International Ins. Services ) Transportation: Volunteer Personal Automobile Use Form Non-District Provided Transportation Non-Dist. Provided Transp.- Field Trips & Excursions-Private Vehicles CRSIG Student Transportation Options & Forms Matrix Volunteers Waivers and Sign-In and Sign-Out Logs Gym – Public Member Use of Gymnasium Gym – Employee Use of Gymnasium Gym – Open Gym Permission and Hold Harmless-Student Gym – Use of Gymnasium Sign-In and Sign-Out Log Workout Room – Use of Workout Room By Employees Workout Room – Employee Work Out Room Sign-In and Sign-Out Log

The Central Region School Insurance Group offers a self-insured dental program through Delta Dental of California. Members choose their plan benefit structure including some orthodontic options from multiple options that are available. For Dental forms please click here.

Secured Member Login This page is for CRSIG Members only. Any unauthorized access to this page is prohibited Member Login -> Origami Member Login -> Please contact CRSIG for instructions, login details and further assistance.

Accessibility Central Region School Insurance Group (CRSIG) is committed to providing access to all individuals—with or without disabilities—seeking information on our website. If you are experiencing difficulty accessing any information on this site, please contact us and provide the URL (web address) of the material you tried to access, the problem you experienced, and your contact information. We’ll contact you and attempt to provide the information you’re seeking. Accessibility Design Guidelines Our website is designed with the consideration of standardized accessibility guidelines. We work to comply with Web Content Accessibility Guidelines 2.0 A and AA. If you have difficulty accessing the site or have any comments or feedback, please do not hesitate to contact us . Browser Accessibility Information Many browsers contain built-in accessibility tools. You can learn more at the links below: Chrome Accessibility Information Microsoft Edge Accessibility Information Firefox Accessibility Information Internet Explorer Accessibility Information

Careers Open Positions Central Region School Insurance Group (CRSIG) currently has no open positions

STOPit is a smartphone and web app that provides a safe, anonymous and comfortable way for students to share inappropriate behaviors and unethical or illegal activity directly to site administrators, in real-time, who can then intervene. Central Region School Insurance Group has partnered with STOPit to provide all of our Property/Liability Program members with a proven solution that deters inappropriate behaviors in schools. Our partnership allows your schools to implement STOPit at no charge. What Students Report Bullying/Cyberbullying Sexual Violence Violence Hazing Weapons Possession Drugs/Alcohol Substance Abuse Intolerance/Discrimination School Benefits Messenger-Anonymous two way chat with reporter Get ahead of situation Reduce the time managing incidents Escalate serious incidents to others Get Help Resources in app STOPit Informational Flyer For More Information Please contact Angela Jacobson at (209) 579-7535 or angela@crsig.com