Technician On-Site Property Damage Report Form

Field form for technicians to document accidental damage to customer property during a visit, capture photos and circumstances, and start a documented claim process.

Submission Notice

• What happens after I submit
• Technician name
  Enter your name so the incident can be traced in the audit trail.
• Technician contact email
  Use a work email address only.
• Customer site or account name
  Use the site or account name only; avoid entering sensitive customer data that is not needed.
• Date of incident
• Approximate time of incident

Incident Details

• Type of property damage
• Description of damaged property
  Briefly describe the item, area, or equipment affected.
• Exact location on site
  Example: kitchen wall near sink, rear loading dock, server room entrance.
• What happened
  Describe the sequence of events leading to the damage. Keep it factual and concise.
• Work activity being performed
• If other, describe the activity

People Involved and Witnesses

• Was a customer contact present?
• Customer contact name
• Customer contact role or title
• Were there witnesses?
• Witness names

Photos and Evidence

• Photos of damage
  Upload clear photos showing the damaged property and context.
• Additional evidence
  Optional supporting files such as a short video or related document.
• Photo notes
  Add any context needed to understand the images.

Immediate Actions and Follow-Up

• Immediate action taken
• If other, describe the immediate action
• Did anyone report an injury?
• Injury details
  Provide only the minimum necessary information for safety follow-up.
• Supervisor notified
• Follow-up needed
• Follow-up notes

Acknowledgment and Submission

• I confirm the information provided is accurate to the best of my knowledge.
• I understand this report will be stored in the audit trail and shared with authorized personnel for claims and follow-up.
• Technician signature
• Date submitted