REAL ESTATE RENTAL FORM
Maintenance/Management
Maintenance/Management
(Download link is below the form)
MAINTENANCE/MANAGEMENT - ACCIDENT REPORT
ACCIDENT / INCIDENT REPORT
TYPE OF INCIDENT: Accident___ Fire__ Medical Emergency__ Crime__ Other__
Address of where happening occurred:_____________________________________
State details regarding any injuries or damages that occurred: (use back of page if needed)
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
Name of residents involved: ______________________________________________
Were any individuals involved that are not current residents of above address?_______ If so, why were they on the premises?_______________________________
Name, addresses and phone numbers of any individuals other than residents of premises.
____________________________________________________________________
____________________________________________________________________
Any witnesses? If so, please give their names, addresses and phone numbers. In your opinion, do you know what may have caused the incident or accident? If so, what?
____________________________________________________________________
Please give the reasons why the cause may have been what you suspect.
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
Name of insurance company and policy numbers of all parties involved (including yours)
____________________________________________________________________
____________________________________________________________________
Has insurance company been notified? __Yes __ No. By phone __ By mail ___ By Phone.
Date and time insurance company was notified? _______________________________
Was the incident documented by use of the following? Photos__ Videotape___
Date and time, fire department, police or emergency personnel was contacted?
______________________ Who was contacted? __________________________
Date and time, someone responded to the situation?__________________________
Follow-up action to be taken by owner or manager ____________________________
____________________________________________________________________
Resident reporting the above incident:________________________________________
Resident’s signature_____________________________________ Date____________
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R.E. RENTAL FORMS - MAINTENANCE/MANAGEMENT - Accident ReportACCIDENT REPORT
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