Equipment and Property Damage Report Form

Employee's Name Submitting Report:*
Department*
Description of Equipment or Property Involved:*
Please choose one:*
- Lost
- Stolen
- Damaged
If lost, what is the last date you remember having it?
MM slash DD slash YYYY
If stolen or damaged, on what date did the incident occur?
MM slash DD slash YYYY
Location:*
If stolen or damaged, where did the incident occur?
At Plant - Above Ground or Below Ground:*
Was the incident on the surface or below ground (i.e. Tunnels)?
Specific Plant Location (above ground)*
Other Plant Locations (above ground):*
Specific Plant Location (below ground - i.e. Tunnels)*
Which Tunnel Entrance was the incident located closest to?
Service Address:*
Street Address City ZIP Code
Description of Street/Field Location:*
Please describe the location using approximate distance from nearest intersection or point of reference.
Describe the Other Location:*
Name of Lift Station
Description of Incident*
Describe the incident that resulted in damage or theft in as much detail as possible. Also describe the specifics of any damage that occurred.
Additional comments:
If you have any additional comments to add to this report or suggestions to prevent this from happening in the future, please add that information here.
Witness(es) to the incident:
Photos (optional)
If you have photos to help support this report, please upload them here.
Drop files here or

Max. file size: 64 MB.
Email*

2710 Curtiss Street
Downers Grove, Illinois 60515-0703

Phone: (630) 969-0664
Fax: (630) 969-0827

Monday-Friday: 8 a.m. - 4:30 p.m.

Saturday and Sunday: Closed

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