Report • CampusOptics

Reporter Info

Email Address* Required

Phone Number* Required

First Name* Required

Last Name* Required

Location

Name* Required

Additional Location Details

Exact Location

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Incident Overview

Department head name:

Contact name:

Contact phone #:

Contact email address:

Date

Time

OTHER

Property Incident Record

Describe the property lost / damaged and the causation in detail:

Estimated dollar value of the loss

List all witness names and contact information (including contractors or employees near the location).

Were measures taken to protect the property from further damage? How?

Yes

No

N/a

Description of mitigation

Can the damaged property be salvaged in any way to minimize the ultimate loss?

Description of salvage options

Was Facilities Management contacted to inspect and repair the loss? If not, who?

Yes

No

N/a

Who completed Inspection and please provide a description of inspection

Did the police, fire or other agency/utility respond to the loss event?

Yes

No

N/a

Agency Name & Contact

Was a police, fire or other agency report filed? If yes, please provide a copy.

Yes

No

N/a

Was there an outside (non-CNU employee) party(s) responsible for the loss?

Yes

No

N/a

Responsible party contact information

Is there a contract with the responsible party? If so, provide a copy of the contract.

Yes

No

N/a

Was any of the University's proprietary/confidential data or other protected personal information lost or compromised in this event?

Yes

No

N/a

Was IT contacted regarding loss of data?

Yes

No

N/a

IT contact name:

Add Supporting Documents

Add files to upload as supporting documentation along with your incident.