Plant & Equipment Damage/Loss/Theft Report Form

• TKL employees and sub-contractors are required to report any damage, loss or theft of TKL owned and operated equipment as soon as possible and should submit a copy of this form within 4 hours of the incident occurring.

• Please note that where an injury occurs as a result of any damage, loss or theft of TKL owned and operated equipment, employees are required to report the incident immediately, and submit a completed Accident Report Form.

Damage / Loss / Theft - Reported By

• Employee Name

• Position/Title

• Phone Number

• Email

Incident Information

• Incident Date & Time

  Date

• Reported Date & Time

  Date

• Supervisor Name

• Building or area where the incident occurred

• Specific Location
  Address
Equipment Information

• Plant or Equipment (damaged, lost or stolen)

  Damaged

  Lost

  Stolen

• Equipment ID

• Equipment Location at Time of Incident

• Take photos of the damage, loss or theft

  Media

• Details

Signatures

• Signature of Operator

  Sign

• Signature of Supervisor

  Sign

For Office Use Only

• Name of office staff dealing with the issue

• Action to be taken

• Does further action need to be taken, if so, what?

• Signature of office staff

  Sign