SUPERVISOR’S PROPERTY DAMAGE
INVESTIGATION REPORT
BOSTON COLLEGE
Last Revised: 9-08
PRELIMINARY
FINAL
LOCATION OF INCIDENT:
DATE OF INCIDENT:
TIME OF INCIDENT:
PERSON REPORTING INCIDENT:
DATE INCIDENT REPORTED:
TO WHOM?
PROVIDE A DESCRIPTION OF LOSS & DAMAGE:
KIND OF LOSS:
FIRE:
WATER:
WIND:
THEFT:
HAIL:
OTHER:
WHAT CAUSED OR CONTRIBUTED TO THE ACCIDENT/INCIDENT:
NAMES OF ANY WITNESSES (ATTACH WITNESS STATEMENTS):
DESCRIBE IN DETAIL THE CORRECTIVE ACTIONS THAT HAVE BEEN TAKEN OR WILL BE TAKEN TO PREVENT RECURRENCE (e.g., equipment
upgrade or purchase, re-instruction or training of employee(s), improved inspection or maintenance procedure, improved signage or labeling, etc.)
PERSON(S) RESPONSIBLE FOR CORRECTIVE ACTIONS:
SUPERVISOR’S SIGNATURE:
DATE(S) FOR COMPLETION OF CORRECTIVE ACTIONS:
DATE:
FACILITY/SITE/DEPT. MANAGER’S SIGNATURE:
PLEASE FORWARD THIS FORM ASAP, PREFERABLY WITHIN 24 HOURS, TO
RISK MANAGEMENT (Fax # 617-522-3357)
DATE: