Today's Date: Date of Incident: Time of Incident: Date Facilities responded: Location of incident (name of building, street address, etc): Areas Affected: Description of how the incident occurred: (example: If you indicate the overhead air handling unit froze, please provide an explanation of how it froze. What was the specific cause?) Description of resulting damage sustained to Brown's property:
In order for resulting damage to be covered by insurance, there needs to be a specific identifiable cause of loss. Work Order Number(s):
Status of work performed: Any other comments?
