Facility Damage Incident Report
Report Date
Reporting Person
Phone/Email
Facility Name / Location
Area/Room Affected
Date of Incident
Time of Incident
Type of Damage
Structural
Water
Fire
Theft/Vandalism
Utility (electric, gas, etc.)
Other
Describe the Incident
Extent of Damage
Actions Taken
Authorities Contacted
Contact Person/Number
Additional Notes