Property Loss Reporting Form

X/Twitter
This field is for validation purposes and should be left unchanged.
Contact Person*
First Last
Contact Email*
Was the loss discovered by you?*
- Yes
- No
Loss reported by Name
First Last
If different than contact person
Loss reported by Email
Department or College*
Division*
Report Date*
MM slash DD slash YYYY
Date of loss*
MM slash DD slash YYYY

Enter date found missing if unknown
Building Name*
Damage Estimate (dollar amount)*
Enter the approximate value of the item(s) lost.
Address*
Street Address Campus Box City State ZIP Code
Description of loss*
What was damaged or lost, cause, surge protection in-place, corrective action, attached reports, photographs, etc.
Actions taken to remediate or prevent further loss
Need to attach pictures / documents?*
- Yes
- No
Upload Document / Pictures
Drop files here or

Accepted file types: jpg, gif, png, pdf, doc, docx, , Max. file size: 195 MB, Max. files: 5.

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