EQUIPMENT DAMAGE / DEFECTIVE / LOSS / THEFT

REPORT
DAMAGE / LOSS / THEFT - REPORTED BY
EMPLOYEE NAME:
POSITION:
CONTACT NO.:
EMPLOYEE ID NO.:
DEPARTMENT:
EMAIL:

EQUIPMENT INFORMATION
EQUIPMENT:
LIST OF EQUIPMENT DAMAGED /
DEFECTIVE / LOSS / STOLEN

EQUIPMENT IDENTIFICATION

EQUIPMENT LOCATION AT TIME

OF DAMAGE / DEFECT / LOSS

REMARKS/NOTES/DETAILS:

INCIDENT INFORMATION (If Applicable)

INCIDENT DATE: PROJECT/SITE:

REPORTED ON:
SPECIFIC LOCATION:
SUPERVISOR:

REMARKS/NOTES:

Note: ALL OCCURRENCE OF DAMAGED/ DEFECTIVE / LOSS AND THEFT OF COMPANY OWNED TOOLS AND
EQUIPMENT SHALL BE REPORTED PROMPTLY TO IMMEDIATE SUPERVISOR/PROJECT IN CHARGE FOR PROPER
DOCUMENTATION AND IN PERSUANT TO PROPER ACTION NEEDED TO BE ADDRESSED IN ACCORDANCE TO
COMPANY POLICY'S RULES AND REGULATIONS.