Information
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Client / Site
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Conducted on
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Completed by
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Name of Damaged item?
Details:
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Who caused the damage to equipment/property?
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Location Damage occurred?
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Serial Number if applicable?
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How did this happen and what is the extent of the damage? (Describe damage.)
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Was anyone injured?
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Please provide name of injured party, details and complete an accident record.
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Action required (please add details in "Notes") <br>Please email Payroll and Line manager re Repair or Replacement request.
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Signature of Supervisor/Manager completing this form.
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Date:
