LOSS & DAMAGE REPORT
Project Name:_____________________________________________________ Date of
Report:_____________
Production
Company:__________________________________________________________________________
Date of Loss or
Damage:_______________________________________________________________________
Location of
Loss/Damage:______________________________________________________________________
Description of Property Lost or Damaged:
____________________________________________________________________ Value: $____________
____________________________________________________________________ Value: $____________
____________________________________________________________________ Value: $____________
____________________________________________________________________ Value: $____________
____________________________________________________________________ Value: $____________
____________________________________________________________________ Value: $____________
Total Value: $
Items Lost/Damaged Were: Purchased (Y/N) Rented (Y/N)
If Lost, When Was the Last Time Property Was
Seen:____________________________________________
Who Was the Last Person to See the Property Before it Was Lost or Damaged:
_____________________________________________________________________________________________
___
Owner of Property Lost/Damaged:
Address:_____________________________________________________________________________________
_____________________________________________________________________________________________
____
Phone#:_____________________________________________________________________________________
__
E-mail
Address:________________________________________________________________________________
Cause of Loss/Damage (i.e. description of incident and how it occurred):
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________
Estimated Cost of L&D:
$______________________________________________________________________
Police Report Attached? (Y/N) Police Report
Number________________________________________
Is Property Damaged Beyond Repair? (Y/N)
Photo of Damage Attached (Y/N)
Other Documentation Attached (Y/N)
Original PO# for
Equipment:___________________________________________________________________
PO# to Replace or
Repair:______________________________________________________________________
L&D Report Completed
By:_____________________________________________________________________
