DAMAGED/LOST EQUIPMENT REPORT
Please fill out this form immediately following an incident involving MAL equipment. If there are multiple incidents please fill out a separate form for each.
Person Reporting (Person filling out form)
Person Reporting Phone Number
Person Reporting Email
Date of Incident
Approximate Time of Incident
Where was the item checked out from?
Media Arts Checkout (HFAC)
FSSS Checkout (MPS)
What item(s) were damaged/lost? Please include barcode numbers so we know exactly which items were damaged/lost?
How was the item broken/lost? Please include detailed description, including: background information, description of event(s), location, and detailed description of damage sustained (if damaged).
Witnesses - Please list one to three witnesses and their contact information.
Person(s) Responsible Phone
Person(s) Responsible Email
Class or Activity this project was for?
Example: TMA 185, Practice Exercise, Fiction Capstone, etc.
Activity Supervisor (Professor/Mentor)
Activity Supervisor Email
Who was the Checkout Attendant who was present when you returned the items?
Should be Empty: