VANDALISM REPORT FORM

No claim will be accepted unless the damage has occurred on school property, during the employee’s shift and with intent.

Date:__________________________

Job Site:_______________________
(where incident occurred)

Position:______________________________________

Name_________________________________________

Address_______________________________________

_______________________________________

Insured Yes_____ No_____

Date of Offence:____________________ Time of Offence:__________________

List of Damages______________________________________________________

____________________________________________________________________

Cost of Damages:_______________________________

Witnesses:_____________________________________

_____________________________________

Investigation by School_______
RCMP_______
Other________

Please complete this form and return to CUPE Local 379 with copies of the following documents attached:

1. Insurance Papers (copy of ICBC claim form).
2. Letter of verification from school administration.
3. Invoices.

N.B. The repairs must have been completed before payment will be issued. These repairs must be completed within three months of the offence taking place.

MoveUP