IT Department
IT Asset Damage Report Form
MPC - ITD - FM - 08
Rev. 0
To be filled out by requestor
Date Prepared
Name of Employee
Position/Title
Department
I. Incident Information
Incident Date
Time of Incident
Reported on
Time Reported
Supervisor
Job Site
Specific Location
II. Equipment Information
Equipment Status
Equipment Asset Tag No.
List of Equipment Damage
Equipment Serial No.
Equipment Location and Time
How Was the Equipment Damaged? (Complete Description)
Description of Damage Equipment
Prepared by
Approved by
Requestor
Department Head
To be filled out by IT
Date Received
Date Encoded
Encoded by