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
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 is the Media Arts Checkout Attendant who was present when you returned the items?
Should be Empty: