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Property Loss Notice by fjwuxn


									                                                                                       Property Loss Notice

Instructions on filing a Property Loss Notice with the Office of Risk Management can be found in the Administrative Policy
and Procedure Manual Section 10.2. In addition, please note the following items:
         1. Department must report loss to Public Safety and obtain a case number before filing a Property Loss Notice.
         2. Property Loss Notice must be filed within 5 days of a reported loss.

 Date of Loss                                Location                               WSU Police Report No.

 Building No.                                Department/Unit                        Date Prepared

 Person Filing Loss Notice                                                          Campus Telephone No.

Cause of Loss (i.e. theft, fire, vandalism, etc.):

Corrective measures taken to prevent future loss:

Description of Property Stolen or Damaged (attach additional sheets if necessary)
Item                            Serial No.                Date Acquired        Cost New               Replacement Cost






Property Office notified via Asset Activity                                            No
Transmittal Form 195 (see A.P.P.M. Section 6.5):                                       Yes – Date:

Office of Risk Management (ORM) Use ONLY
Claim:               Verified    Approved for $                                           .
                     Denied:     a)       Mysterious disappearance (refer to A.P.P.M. section 10.2)
                                 b)       Under $500 deductible (refer to A.P.P.M. section 10.2)
                                 c)       Lack of equipment security (refer to A.P.P.M. section 9.2)
                                 d)       Other (explain below)

ORM Signature/Date

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