Incident Report Form for STAFF
Please fill this form if you want to report a device with a PHYSICAL INCIDENT. DO NOT use this form to report an incident that is related to a student.
Email address *
School Name *
Please choose your school
Staff Full Name *
Incident Location *
Samples: Room 301, Cafeteria, Home,...
Incident Date *
MM
/
DD
/
YYYY
Incident Time *
Time
:
Device *
Device Samples: Laptop, Desktop, Hotspot, Phone, Projector, Camera,...
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) *
If there is no a witness, please say " no witness"
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.
Submit
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