TITLE: Guest/Staff Property Loss Incident Report

DOCUMENT NUMBER: GSPL001

APPROVED BY: Accor Technical Services
ISSUE DATE: January 2022
DATE LAST REVIEWED: 2022
DATE OF NEXT REVIEW: January 2022

GUEST/STAFF PROPERTY LOSS/DAMAGE INCIDENT REPORT-

NOT TO BE USED FOR INCIDENTS INVOLVING ANY PERSONAL INJURY

NATURE OF INCIDENT: GRAND MERCURE MALANG MIRAMA

Hotel Ref No: H 9824
DATE OF REPORT: 01/01/2022 TIME OF REPORT: 02.32 am/pm

THEFT/LOSS DAMAGE COMPLAINT OTHER (describe under)

DETAILS:

Location of Incident:
Lobby Area
Day: Date: Time of incident: am/pm
Saturday 01/01/2022 10 : 37
Reported by: Date: Time: am/pm
Novario Wirastri H. 02/01/2022 02.32
 House guest Date arrival Date departure Visitor Staff member
Room No: 1512 31/12/21 01/01/22 Department: Front Office
NAME
Novario Wirastri H.
ADDRESS

PHONE CONTACT Home Mobile Email

FULL FACTS OF INCIDENT: Use second page if required

On Saturday, 01 January 2022, Nova handle Mr. Agung Krispimandoyo for check out at Front Office
Counter. The guest complaint about the sound above his room and explain that he already informs to
Operator by telephone for 8 times and still did not any follow up regard his complaint. Nova has

apologized and suggest to the guest to meet the MOD and EAM, however the guest rejects it and just
want to leave the Hotel as soon as possible. The Guest feel disappointed for his experience during his
stay in this Hotel.

WITNESSES (IF ANY):

ACTION TAKEN:

Nova informs to FOM & EAM after handle the guest.

Document prepared by JAG Pty. Ltd and remains property of this company
 POLICE/EMERGENCY SERVICES ATTEND: YES/NO

TIME CALLED :

ARRIVED :
OFFICERS NAMES :

STATION :

POLICE EVENT NO:

SEVERITY POTENTIAL MAJOR SERIOUS MINOR

RECURRENCE POTENTIAL MAJOR SERIOUS MINOR

DUTY MANAGER INFORMED YES/NO

SIGN
CHIEF SECURITY INFORMED YES/NO
SIGN
GENERAL MANAGER YES/NO
SIGN

PRINT CLEARLY WHEN COMPLETING FORM/ADDITIONAL INFORMATION ATTACH SEPARATE SHEET.

ORIGINAL FILED AT HOTEL – C.C. TO INSURANCE BROKER AND JAG P/L WHERE APPROPRIATE.

PAGE TWO.

Additional information.

Document prepared by JAG Pty. Ltd and remains property of this company