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Asset Damage Incident Report

An asset damage incident report documents an incident that occurred on [DATE] at [TIME] in [LOCATION] involving an asset checked out to [NAME]. The report notes that [DESCRIPTION OF INCIDENT], and that [INJURY DETAILS]. It suggests that the incident could have been prevented by [PREVENTION DETAILS]. The damaged asset is listed as [ASSET] and was checked out to [NAME].

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Jon Watkins
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2K views

Asset Damage Incident Report

An asset damage incident report documents an incident that occurred on [DATE] at [TIME] in [LOCATION] involving an asset checked out to [NAME]. The report notes that [DESCRIPTION OF INCIDENT], and that [INJURY DETAILS]. It suggests that the incident could have been prevented by [PREVENTION DETAILS]. The damaged asset is listed as [ASSET] and was checked out to [NAME].

Uploaded by

Jon Watkins
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Asset Damage Incident Report

Date of incident: _________________________________________ Time of incident: ____________________


Location incident happened: __________________________________________________________________
Name of person with the asset: ________________________________________________________________
Department person works for: _________________________________ Supervisor: ______________________
What happened:
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Was anyone injured:
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
What could have prevented this from happening:
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Asset that got damaged: ________________________________ Checked out to: ________________________
By signing below you are not admitting to any guilt or taking liability of the incident. By signing below you are
saying that all the information above is correct to the best of your knowledge. If you need more space please
use a separate sheet of paper.
Sign: ______________________________________________________ Date: __________________________

DO NOT WRITE ON THIS SIDE. TO BE FILLED OUT BY ADMINISTRATION ONLY


******************************************************************************************
Employee: ________________________________________ A Number: _______________________________
Prior incidents: _____________ Total cost for this incident: _________________________________________
Further Investigation: ___ YES ___ NO

Continued By: ____________________________________

Asset Condition: ______________________________ Will asset be REPLACED or REPAIRED: _______________


Location of the asset: ________________________________________________________________________
Further action to take place:
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Reports filed with this IR include:
__ IR __Pictures __Witness Statement(s) __ Follow up Investigation __Police Report __ Asset Condition Scale
Administration: ___________________________________________________ Date: ____________________
Department Supervisor: ____________________________________________ Date: ____________________
Director: _________________________________________________________ Date: ___________________

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