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Risk and Insurance Services
Property Damage Report Form
(other than auto*)
Please return the completed form to Risk and Insurance Services, 208 Elizabeth Avenue, fax 709-864-8823, or email
enterpriserisk@mun.ca, prior to incurring any costs.
Department:
Employee/Contact Information Name:
Phone No:
Fax No:
Email:
Date of Incident: Time:
Location of Incident:
Type of Loss: Water Damage Theft
Fire Vandalism Other
Description of the Property (including model number, serial number, age, etc.):
Description of the damage:
Description of how the incident occurred:
Approximate cost of repairs: Approximate cost of replacement:
Employee filing this report:
Print Name Position
Signature Date
*for auto claims, please complete the Automobile Accident Report Form