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Chromebook Incident Report: Please complete all sections in detail in order to process the Accidental Insurance. If there is not enough detail chromebooks will not be repaired.
Please complete this form with as much information as possible. If you are experiencing issues with your device not powering on or charging, please follow the troubleshoot directions at this link:
bit.ly/SMMDLP
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* Required
Email
*
Your email
When did you notice the issue?
*
MM
/
DD
/
YYYY
School Site
*
Choose
John Adams Middle School
Lincoln Middle School
Malibu MS (6-8)
Malibu HS (9-12)
Olympic High School
SMASH
Santa Monica High School
Grade level
*
Choose
6th
7th
8th
Freshman
Sophmore
Junior
Senior
Last name
*
Your answer
First name
*
Your answer
Student ID#
*
Your answer
Phone number for us to reach you to troubleshoot
*
Your answer
What is the problem with your Chromebook?
*
charger
keys
screen
trackpad
will not charge (BEFORE YOU SUBMIT THIS FORM, please visit the troubleshooting website here:
bit.ly/SMMDLP
)
will not connect to the internet
will not power on (BEFORE YOU SUBMIT THIS FORM, please visit the troubleshooting website here:
bit.ly/SMMDLP
)
black screen
lost
stolen
Other:
Please explain in a couple sentences what happened to your Chromebook. For example - If the screen broke, how did it happen?
*
Your answer
Chromebook Asset Tag #:
*
The asset tag is located underneath your Chromebook.
Your answer
Was this an accident?
*
Yes
No
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This form was created inside of Santa Monica-Malibu Unified School District K-12.
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