Property Loss Claim Reporting Form

Please complete the form below to report a Property Claim Loss in your district.

District Name:(Required)

Campus or Location Name:

Address:

Contact Name:

Email:(Required)

Phone Number:(Required)

Fax Number:

Type of Property Loss:

Damage to automobile\ vehicle – use Liability & Automobile Physical Damage Reporting Form

Damage to district owned property other than an automobile\ vehicle (complete Property Loss section next)

Date of Property Loss:

MM slash DD slash YYYY

Location of Damaged Property:

Please Provide a Description of the Events Leading to the District’s Damaged Property:

What Caused the Loss\Damage?

Lightning

Hail

Theft

Flood

Fire

Wind

None of the Above

If None of the Above, Describe the Cause Here:

To Whom was the Loss Reported?

Police

Fire Department

Please Provide Contact Names for Obtaining Reports from Above:

What is the Estimated Value of the Loss (if known):

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