Damaged Equipment Form
LIMITLESS POSSIBILITIES COMMUNITY CENTER
Reported on
*
/
Month
/
Day
Year
Date
Equipment was assigned to
*
First Name
Last Name
Department
*
Email
example@example.com
Damaged Equipment Information
*
Details of the Damage
*
Attach the Photos of Damaged Equipment
Browse Files
Cancel
of
Supervisor Name
*
First Name
Last Name
Supervisor Comments/Notes
*
Date
*
-
Month
-
Day
Year
Date
Supervisor Signature
*
Should be Empty: