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PROPERTY DAMAGE REPORT

FOR NAU EMPLOYEES AND STUDENTS ONLY

PROPERTY DAMAGE REPORT: The following report is to be filled out and submitted to Property and Liablity Insurance Services. Services for all non-criminal damages to state-owned property or personal property. If the loss was due to criminal activity (graffiti, theft, vandalism) or involves a multi vehicle accident or injury, please contact NAU Police Department dispatch at 523-3611 to file a police report.

Instructions:

FILL OUT ALL FIELDS AS COMPLETELY AS POSSIBLE
REMEMBER TO INCLUDE DESCRIPTIVE INFORMATION
IN THE EVENT OF WATER DAMAGE TO STATE FACILITIES, REFER TO "WATER DAMAGE RESTORATION GUIDELINE" PROCEDURES.
MOVE FROM ONE BOX TO THE NEXT BY PRESSING THE TAB "KEY", OR USE YOUR MOUSE. DO NOT PRESS ENTER. THIS WILL CLOSE THE FORM & IT WILL BE SUBMITTED TO SES BLANK.
YOU MAY PRINT A COPY FOR YOUR RECORDS AFTER YOU PRESS "SUBMIT"
ONLY PRESS "SUBMIT" ONCE
IF YOU HAVE ANY QUESTIONS CONCERNING THE REPORTING PROCESS FOR DAMAGED PROPERTY, PLEASE CONTACT Property and Liablity Insurance Services 928- 523-4557.
IF DAMAGE IS DUE TO VANDALISM OR CRIMINAL DAMAGE PLEASE CALL THE NAU POLICE DEPARTMENT AT 928-523-3611.



NAU (State-owned) Property - When property of the state (Northern Arizona University) is damaged, a "Damage to State Property" report must be filed with NAU PLIS. If you are an employee of the University, or a departmental representative who wishes to report damage to Northern Arizona University property, please check the appropriate box below, and complete the rest of the form. The report form is e-mailed to the SES Insurance Officer for possible insurance claims processing. If necessary, the Insurance Officer will telephone you to get additional information.



Personal Property - If you feel your personal property was damaged as a direct result of University responsibility, you may fill out a "Damage to Personal Property" report. Example: An NAU employee accidentally damages your electronic equipment while repairing your residence hall room. Follow the above instructions.

Check Type Of Report

Choose Damage to STATE or PERSONAL property

DATE & LOCATION INFORMATION

Date Occurred
Time Occurred
Date Reported
Time Reported
City:
County:
State:

NAU Campus Location:

Building Name
Room#
Building #
Parking Lot
Weather Conditions during time of occurrence:

Reporting Party Information

First name
Middle Initial
Last name
NAU ID#
D.O.B.
Your Department Name
Occupation
E-mail Address
Home Phone Number
Work Phone Number
Home Address

Driver and State Vehicle Information

The following information must be provided for damage to state vehicles or damage to rental vehicles used for university business:
Driver's Full Name
Driver's License Number
State License Issued
Expiration Date
Driver's NAU Department
Driver's Occupation
NAU Department Address
Work Phone Number
Supervisor's Name

Information on State Vehicle Damaged

Vehicle License Number
Vehicle Number
Vehicle Year
Make and Model
VIN Number

Description of Damaged Property

Describe damage to State vehicle or property: (example: windshield cracked by rock, or DELL OptiPlex GX1p Computer received water damage.)

Narrative

Please give detailed information on how damage occurred.
State property losses that are not reported to Property and Liablity Insurance Services in a timely manner may not be covered. State property losses not reported to State Risk Management within 90 days of date of discovery will not be covered.

Contact Us

NAU Police Department
PO Box 5602
Building 98A
Flagstaff, Arizona 86011

Phone: (928) 523-3611
Emergency: 911 or
523-3000


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South San Francisco Street, Flagstaff, Arizona 86011