Date of Incident:
Time of Incident:
Date Facilities responded:
Location of incident (name of building, street address, etc):
Description of how the incident occurred:
(example: If you indicate the overhead air handling unit froze, please provide an explanation of how it froze. What was the specific cause?)
Description of resulting damage sustained to Brown's property:
In order for resulting damage to be covered by insurance, there needs to be a specific identifiable cause of loss.
Work Order Number(s):
Status of work performed:
Any other comments?
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