LOSS, DAMAGE or DESTRUCTION of PROPERTY REPORT

							[Company Logo Here]

                                  LOSS, DAMAGE or DESTRUCTION of PROPERTY REPORT


           REPORT #: LDD-[project]-000                                   REPORT DATE: ______________
[Your company info] personnel shall use this form to report all instances of loss, damage or destruction of [property
owner] owned property that is accountable to the [Project detail]. The Site Manager shall provide all reports to the
[project code] Program Manager.


PROGRAM: [Project name and location]


CONTRACT NUMBER:                              TASK ORDER NUMBER: ___________________________


TASK ORDER DESCRIPTION: ____________________                 CHARGE NUMBER: _________________________


ASSET NUMBER: ____________________


DESCRIPTION: _________________________________________________


MANUFACTURER: _____________________                  MODEL NUMBER: ________________________________


SERIAL NUMBER: __________________________________________________________________________


ACQUISITION DATE: _____________________              ACQUISITION DOCUMENT #: _________________________


VENDOR: ______________________________               PURCHASE PRICE: ______________________________


CURRENT VALUE: _______________________               ESTIMATED REPLACEMENT COST: __________________


DEPARTMENT, SECTOR OR AREA: ______________________                   LOCATION: __________________________


ASSIGNEE OR USER NAME: __________________________________________________________________


DATE OF THE INCIDENT: _________________              LOSS, DAMAGE OR DESTRUCTION? _________________
DESCRIPTION OF THE INCIDENT: ___________________________________________________________________
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                         LOSS, DAMAGE or DESTRUCTION of [Project] PROPERTY
                                  Report Number: LDD-AIRP-000001


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IDENTIFY THE WITNESSING PARTIES: _________________________________________________________


PROVIDE ANY ADDITIONAL RELEVANT INFORMATION: ___________________________________________
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SECURITY DEPARTMENT INVESTIGATION RESULTS, IF APPLICABLE: ________________________________
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IF DAMAGED, PROVIDE THE ESTIMATED COST OF REPAIR: ________________________________________


HOW CAN THE ITEM BE REPAIRED?: ___________________________________________________________


WHAT VENDOR CAN REPAIR THE ITEM?: _______________________________________________________
IS THERE ANY INSURANCE ON THIS ITEM?: ________      IF YES, LIST THE AMOUNT: ___________________


WILL THERE BE ANY REIMBURSEMENT FOR THIS INCIDENT?: _______        IF YES, LIST THE AMOUNT: ______


DESCRIBE THE IMPLEMENTED CORRECTIVE ACTION THAT WILL PREVENT THIS INCIDENT FROM
REOCCURRING: ____________________________________________________________________________
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                         LOSS, DAMAGE or DESTRUCTION of [Project] PROPERTY
                                   Report Number: LDD-AIRP-000001

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                                            APPROVALS


                    PRINTED NAME                          SIGNATURE                    DATE


Assignee or User:


Site Manager:


Program Manager:




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