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.
Please choose your school
HSA EL PASO (Harmony Science Academy - El Paso)
HSI EL PASO (Harmony School Of Innovation - El Paso)
HSE EL PASO (Harmony School of Excellence - El Paso)
HSS EL PASO(Harmony School of Science - El Paso)
HSA ODESSA(Harmony Science Academy - Odessa)
HSA LUBBOCK(Harmony Science Academy - Lubbock)
Staff Full Name
Samples: Room 301, Cafeteria, Home,...
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)
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.
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This form was created inside of Harmony Public Schools.