Property Loss Report
Department__________________________________________ Date ______________
Completed by ________________________________________ Date ______________
Cause of Loss Type of Loss
T Theft T Property Damage
T Vandalism T Inventory
T Burglary a Money/Cash
a Tools and Equipment a Tools and Equipment
a Fire/Arson a Employee Time
a Accident—Damage a Business Interruption
a Unexplained a Other:
_________________________________________
___________________________________________
_____
_ Other:
_______________________________________
_______________________________________
Date and time loss occurred _______________________________________________________
Date and time loss reported _______________________________________________________
D Police report made Report ID # ___________________________________________
List police department contacts and notes ____________________________________________
______________________________________________________________________________
Besides the property loss, were there any other consequences of the loss? __________________
______________________________________________________________________________
______________________________________________________________________________
Could this loss have been avoided? C Yes i No
If yes, how? ___________________________________________________________________
______________________________________________________________________________
Other comments, notes: __________________________________________________________
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