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University Property Incident Report Form

Complete this form in the event of university property loss including, but not limited to, cases of fire, flood or theft.

NOTE: This form only pertains to university property. Personal property loss is not covered under the university’s insurance policy unless pre-approved by the university's department that said personal property is to be used as a Queen's University business requirement.

After completing this form, please complete the Items Claimed for Repair or Replacement Excel sheet and have the departmental administrator submit both forms to the office of insurance and risk management at insurance@queensu.ca.

Personal Contact Information
Incident Information
:
$
Witness Information
First Responders
Please fill this in if you answered "yes" to both the above questions.
Additional Information