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Property Loss Report
CONFIDENTIAL REPORT
This report is confidential and is intended to be submitted to SMCSIG's claims administrator and district's legal counsel for use in recovering losses and defending litigation.
Cause of Property Loss or Damage
School
*
School District
*
School Address
*
Principal's Name
*
School Phone Number
*
Name of Employee(s) who had care or custody
Name
*
Department
*
Name
Department
Please list the missing items or property damaged
*
Attach a copy of the Police and/or Fire Report(s)
Upload File
How were items damaged or stolen?
*
Please explain how the building was entered
*
Was alarm activated?
Yes
No
Were police notified?
Yes
No
Rooms Entered
*
Date and Time of Entry
*
Month
Day
Year
Time
:
Hours
Minutes
AM
Who discovered the damage?
*
Date and Time of Discovery
Month
Day
Year
Time
:
Hours
Minutes
AM
Estimated Cost of Repair or Replacement
*
Attach Inventory of Items Damaged or Stolen
Upload File
Suggestions to prevent similar incidents in the future
*
Reported By
*
Title
*
Phone
*
Date
*
Signature
*
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