Information

  • Conducted on

  • Location

Incident

  • Situation Found

  • Type of Action Taken

Owner / Occupant

  • Owner Name

  • Owner Address

  • Owner Phone Number

  • Occupant Name

  • Occupant Address

  • Occupant Phone Number

Other Agencies Involved

  • Fire Dept.

  • Law Enforcement

  • EMS

  • Other

Estimated Total Loss

  • Estimated Loss

  • Photo

  • Estimated By

Remarks

  • Remarks

  • Form Filled Out By

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.