Establishment name Cost centre First name Last name Email address Telephone number Address Postcode Incident details Type of damage Theft Vandalism Accidental damage Fire Storm or water Impact Pick all that apply. Date of incident / Date of damage discovery Day Month Year Time of incident Estimate of total cost of loss/repairs/replacement Location of incident Description of incident including details of damage Were the police advised? Yes No Name of Police Officer Name of station Crime reference number Preventative measures implemented as a result of the incident
