Damaged Equipment Form
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Todays Date *
MM
/
DD
/
YYYY
Room Number that Item was Damaged In *
Date of Vandalism (approx.)
MM
/
DD
/
YYYY
Time
:
Person Who Discovered Damage *
Who was the damage reported to? *
Nature of Incident *
Action Taken *
Approximate Cost of Damage *
Type of damage done to the Equipment *
Missing Items *
Police Report Filed *
Required
Insurance Claim filed *
Submit
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This form was created inside of Wayne County Schools Career Center.

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