Damage Assessment
Date the damage was found:
*
-
Month
-
Day
Year
Date
Reason for being in resident's room:
*
Please Select
Safety Checks
Visiting
Welfare Check
Resident Notification
Other
Residence Hall
*
Please Select
Centennial Hall
Mustang Village AN
Mustang Village AS
Mustang Village B
Mustang Village C
Muir Heights
Room Number
*
Common Area, Bedroom, or Bathroom
*
Please Select
Common Area
Bathroom
Bedroom
Resident Name
*
First Name
Last Name
W Number
*
Email
example@example.com
Resident Name
First Name
Last Name
W Number
Email
example@example.com
Resident Name
First Name
Last Name
W Number
Email
example@example.com
Resident Name
First Name
Last Name
W Number
Email
example@example.com
Resident Name
First Name
Last Name
W Number
Email
example@example.com
Please pick a category under which the damage(s) fall under.
*
Windows/ Screens
Blinds
Furniture
Wardrobe/Closet
Kitchenette
Bathroom
Doors
Floors
Kitchen
Other
Please describe the damage.
*
Found By
*
Name
RA/HD Identifier
*
4 Digit Code
Upload photos of damage
*
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Resident Signature
Hall Director Notes
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