Property Damage
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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 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 Other.
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