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A leading research university in Atlanta, Georgia


IMPORTANT NUMBERS

GSU Police Department
404/413-3333

GSU Student Health Clinic
404/413-1930

University Housing
404/413-1800

Hazardous Waste
404/413-3551

Radiological Safety
404/413-3540 


IMPORTANT LINKS

Need a safety escort?
GSU Police Department

Problem in the dorm?
University Housing

Having health issues?
Student Health Clinic

Worried about lab safety?
Compliance and Safety

Time for a clean up?
Facilities Management

 

Property Damage Report

General Information

 

Department:

Employee Name:

Email Address:

Phone Number:

Fax Number:

 

Incident Information

 

Date of Incident:

 

Time of Incident:

AM

PM

 

Location of Incident:

 

Building:

Room:

 

Type of Loss:

Property Damage

Vandalism

Fire

Water Damage

Theft

Other: 

Incident Description

 

Description of How the Incident Occurred:

 

Description of Property Damage (List items with GSU Property No., Serial No., Model No.):

 

Witnesses Names and Addresses:

 

Cost (check ONE in each column below):

Estimate

  Invoice

$ 

Replacement Cost

Repair Cost 

$ 

 

Bills Being Sent to Safety and Risk Management? Yes No

 

** For Transient State Property Only:

Has the Transient State Property Form been submitted to Safety and Risk Management?

Yes No

 

 

Employee Filing This Report

 

Name of Employee Filing this Report: 

Phone Number: 

Date: