Report Loss or Damage - Security Investigations

NOTIFICATION OF LOSS OR DAMAGE TO STATE OWNED PROPERTY

Instructions: Please use this form to report all losses or damages to state owned property.

A. When reporting a loss (that is not due to suspected theft, vandalism, criminal or malicious activity), forward report to DOT SECURITY DIVISION.

B. When reporting a loss that is due to suspected theft, vandalism, criminal or malicious activity, forward the report to the DOT SECURITY DIVISION and report the incident immediately to STATE OR LOCAL POLICE.

Report Of

Reported To

Police Department

District

Police Case Number

Date Reported

Date Of Incident

Time

Reported By

Building Number

Location Occurred

Office Location

Telephone

Discovered By

Information Taken By

Brief Description of Property Lost or Damaged

Approximate Value

Equipment Description Tag Number – Serial Number – Equipment Number - Vehicle Registration

Cause Of Loss

What steps have been taken within your agency to prevent a recurrence? Explain

Miscellaneous (If loss or damage was not reported immediately, indicate reason)

Security

Name of Individual to be Contacted

Telephone

Date