Incident Report Form for Students
Please fill this form if you want to report a device with a PHYSICAL INCIDENT. This form is only for students but it can be filled on behalf of students.
Email address *
School Name *
Please choose your school
Full Name of Who is Filling the Form *
If you are filling this form on behalf of a student, please leave your name here. If you are the student, please leave your email here.
Student Full Name *
Please leave the student's name here involved with the incident
Student’s ID Number *
Incident Location *
If it happened at the school, please leave classroom number here. If it happened at the student home, please leave "home" here.
Incident Date *
MM
/
DD
/
YYYY
Incident Time *
Time
:
Device *
Device Samples: Chromebook, Desktop, Laptop, Hotspot, Phone, Projector,...
Asset Tag No *
Please type the asset tag number here. It is located on back cover of the device. (The asset tag is either red or blue color and is 7 digits)
Witness (es) *
Supervisor /Parent Name *
Please leave the supervisor/parent name here who is at the incident location when it happened.
What is the damage to the device? *
Samples: Broken hinge, Broken Screen, Broken Keyboard,...
Details of the Incident *
For insurance purposes please provide and elaborate detailed summary about the incident.
A copy of your responses will be emailed to the address you provided.
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