This form must be completed within 2 hours of the YWCA employee learning of the incident. Please check the box below in which the incident identifies under.
Building Damage Report?
Hazardous Situation from Building Damage?
Name of person filing report?
Employee involved with the incident or building only?
Date & Time of Incident?
Date & Time Reported?
DESCRIPTION OF DAMAGES OR INCIDENT IN DETAIL.
Property damage include IT equipment?
If yes, list what IT equipment is damaged:
Property damage include tenant's personal items?
If yes, describe what was damaged:
Property damage include breech in securities?
If yes, itemize what doors, windows, units, locked rooms, or other entrances that were breeched:
Property damage believed to exceed $5,000.00 in repairs at the time of the incident? No.
If yes, itemize what repairs are needed:
Property damage tenant caused or building malfunction?
If tenant caused, please identify which unit they live in: No.
THIS SECTION TO BE COMPLETED AFTER INCIDENT IS REPORTED. PLEASE MARK WHAT STEPS ARE COMPLETED BELOW:
Personnel contacted regarding incident?
Please describe steps made after the incident or damage occurred:
Attach pictures of incident if any
Add or drag pictures
Signature of Supervisor: Kevin Kelstrom
Click here to sign
Source: YWCA SEATTLE (Community Member)