HTML Preview Equipment Damage Report page number 1.
Templates and policies from HRDownloads.com are provided for clients of our service. Customers may use this
document as is, or as a starting point for their own documents. HRDownloads.com assumes no responsibility for the
enforcement or effectiveness of its templates and policies. Always consult legal counsel before implementing any new
policies or procedures at your organization.
Equipment Damage / Loss / Theft Report Form
(Company Name) employees are required to report any damage, loss or theft of
(Company Name) owned and operated equipment as soon as possible and submit a
completed copy of this form within (XXXX) hours of the incident.
Please note that where an injury occurs as a result of any damage, loss or theft of
(Company Name) owned and operated equipment, employees are required to report the
incident immediately, and submit a completed Incident Report and Investigation Form.
Damage / Loss / Theft - Reported By
Employee Name: Employee Number:
Position/Title: Department:
Company Phone: Company Email:
Incident Information
Incident Date (dd/mm/yy): ___/___/___ Time of Incident (24 hour clock):
Reported on: ___/___/___ Time Reported (24 hour clock):
Supervisor: Building/Area: Specific Location:
Equipment Information
List of Equipment
Damaged / Lost / Stolen
(Please Specify)
Equipment Identification
Number(s)
Equipment Location at
Time of Damage / Loss