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  • Sample Incident Report - Lost - Damaged Item

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    Marilyn
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    This incident report from a municipality documents a lost or damaged item. It records the complainant's information, details of the lost/damaged item, and a narration of the incident. The report notes the date, time, location of incident, person first notified, and their remarks. It is signed by the complainant and person who received the IROLDI report.

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    A document for incident report of lost / damaged item

    Original Title

    Sample Incident Report_Lost_Damaged Item

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    This incident report from a municipality documents a lost or damaged item. It records the complainant's information, details of the lost/damaged item, and a narration of the incident. The report notes the date, time, location of incident, person first notified, and their remarks. It is signed by the complainant and person who received the IROLDI report.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    1K views1 page

    Sample Incident Report - Lost - Damaged Item

    Uploaded by

    Marilyn
    This incident report from a municipality documents a lost or damaged item. It records the complainant's information, details of the lost/damaged item, and a narration of the incident. The report notes the date, time, location of incident, person first notified, and their remarks. It is signed by the complainant and person who received the IROLDI report.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    of 1

    Republic of the Philippines

    Province of __________
    Municipality of ____________
    BARANGAY _____________

    INCIDENT REPORT OF LOST/DAMAGED ITEMS

    Date: ________________________ IROLDI No: ____________________

    A. DATA OF COMPLAINANT
    a. Name : ___________________________________________________________________
    b. Address: ___________________________________________________________________
    c. Contact Number: _____________________________________________________________
    B. DATA OF COMPLAINTS
    a. Item/s lost or damaged: ________________________________________________________
    b. Description of the lost/damaged item/s: ___________________________________________
    _____________________________________________________________________________
    _____________________________________________________________________________
    _____________________________________________________________________________

    Date of Incident: ___________________________ Time of Incident: ___________________________


    Place of Incident ______________________________________________________________________
    Person First Notified: __________________________________________________________________
    Remarks of the Person First Notified: _____________________________________________________
    ____________________________________________________________________________________
    ____________________________________________________________________________________
    ____________________________________________________________________________________
    ____________________________________________________________________________________

    ________________________________________
    Printed Name & Signature of the Person Notified

    C. DETAILED NARRATION OF THE INCIDENT (Please use additional page if necessary & WRITE LEGIBLY)
    ______________________________________________________________________________________
    ______________________________________________________________________________________
    ______________________________________________________________________________________
    ______________________________________________________________________________________
    ______________________________________________________________________________________
    ______________________________________________________________________________________
    ______________________________________________________________________________________
    ______________________________________________________________________________________
    ______________________________________________________________________________________

    __________________________________
    Complainant’s Signature

    IROLDI Received by:

    _______________________________
    Printed Name & Signature

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