MONTANA STATE UNIVERSITY
FACULTY/STAFF FOREIGN TRAVEL
INSURANCE REPORTING FORM

 EMPLOYEE NAME:

 DEPARTMENT:

 EMPLOYEE SALARY: (Annual)

 TRAVELING TO: (list all countries)

 PURPOSE OF TRAVEL:

 DATE OF DEPARTURE:

 DATE OF RETURN: 

WILL STUDENTS ALSO PARTICIPATE IN TRAVEL?:         

 WILL OTHER FACULTY/STAFF PARTICIPATE IN TRAVEL?:

 WILL FAMILY MEMBER(S) PARTICIPATE IN TRAVEL?:

 
The above information must be reported to MSU Safety and Risk Management for each trip to a foreign country or destination by EACH MSU faculty or staff member.  Reporting all travel plans will confirm that foreign worker’s compensation insurance coverage, foreign liability coverage and travel assistance services are in effect for the employee’s foreign travel.