Incident Template

When did you notice this?*

MonthDayYear

Please Select Location of the Problem/ Repair/ Issue:

Briefly Describe Problem/ Repair/ Issue:*

Be specific, furniture, plumbing, decor, etc

Do you have more information to help the House Committee fix this?

Can you help with this repair? or do you have a suggestion? or a referral?

Urgency or Priority:

Would be nice... (this quarter)Soon please. (this month)CALL 911! (now, it's dangerous)

My Name:*

My E-mail Address:*

For further questions please refer to the

HC Chair, Greg Bernson: housecommittee@elks1108.org

ER, Doug Monti: dzmonti@aol.com

Lodge Maintenance Report