Breakage and Damage Form

Breakage and Damage Form
Client's Name

First NameLast Name
Date Of Service

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Team:

Other
Techs Name:
What was broken?
Front of Item
Left Side
Right Side
Back of Item
Close up of damage or broken area
Picture of brand or label
Extra Picture
Is there a price tag? How much?
Brand or Label from item?
What room was it in?
What Happened?
If the client is home, Did you update them?
Should be Empty: