Incident/property Damage Report Form printable pdf download

Incident/property Damage Report Form

1000 5 Street, Suite: 1316

Miami Beach, FL 33139

P: 7864564758 | E: Info@AvantagePM.com

INCIDENT/PROPERTY DAMAGE REPORT FORM

Reported by: _______________________ Dept._____________________ Date: ________

Date of Incident:_________________ Time of Incident: _____________ a.m. ______________ p.m.

Location of Incident : ___________________________________

Was Police Dept. Notified ______ Yes ______ No Fire Dept. _____ Yes ______ No

Incident Report

Please provide a brief description of the type of damage:

______ Injury to Person ________________________________________________________

______ Damage to Property _____________________________________________________

______ Other ________________________________________________________________

Name of Party _________________________________

Phone ________________________

Address (Include complete address, Street address, City, State, Zip)

__________________________________________________________________________

Briefly Describe What Happened:

__________________________________________________________________________

Did party indicate intent to file a claim against agency? _____ Yes ______ No

Incident Activity Log:

Date

____________

Comments

______________________________

Diary/Activity

_____________________________________________________________________________________

Incident/property Damage Report Form