PERSONAL PROPERTY DAMAGE FORM (***Not Auto Accident***)
***Drivers of Koopman Lumber Vehicles will STILL be required to complete the hand written form attached to this task, and submit it to their Supervisor*** The Supervisor/Manager will then complete this JotForm, and attach the employee report and pictures for distribution.
PERSON SUBMITTING FORM:
Name:
*
First Name
Last Name
Email:
*
example@example.com
Phone:
*
Please enter a valid phone number.
Store Location:
*
Please Select
Andover
Dennis
Fairhaven
Hudson
Indian Orchard
Milford
North Grafton
Pembroke
Sharon
Uxbridge
Uxbridge Paint
Whitinsville
Berlin, CT
Cheshire, CT
East Hampton, CT
Meriden, CT
Kitchen & Bath
Estimating & EWP
Purchasing
Whitinsville Store Admin
Sutton Admin
Marketing
Accounts Payable
Credit Dept
Human Resources
IT
Service Department
Lumber Sales
Inside Sales
Other
EMPLOYEE INVOLVED IN PROPERTY ACCIDENT:
Name:
*
First Name
Last Name
Date of Property Damage:
*
-
Month
-
Day
Year
Date
Address of Property Damage:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
ATTACH PROPERTY DAMAGE REPORT HERE:
Attach/Upload:
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
PLEASE ATTACH PICTURES OF DAMAGE HERE:
Attach/Upload:
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Submit
Should be Empty: