Free Damage Report for Insurance Claim Template
DAMAGE REPORT FOR INSURANCE CLAIM
Reported by: [Your Name]
I. Incident Details
Date of Incident: November 10, 2052
Time of Incident: 3:15 PM
Location of Incident: Raleigh, NC 27601
Claim Number: CLAIM123456
Policy Number: POLICY789101
II. Description of Damage
A fire broke out in the main server room of the office building on November 10, 2052. The fire caused significant damage to the server rack, communication equipment, and office furniture. Additionally, water damage was caused by the activated sprinkler system. The fire started due to an electrical malfunction in the server room's power supply unit.
III. Cause of Damage
The fire was triggered by an electrical fault in the power supply unit of the server room, leading to overheating and ignition. The fire spread to nearby equipment.
IV. Immediate Action Taken
-
The fire department was called, and emergency services responded within 10 minutes.
-
The office building’s sprinkler system was activated, containing the fire.
-
Employees were evacuated safely.
-
IT support initiated data recovery from backup systems.
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Areas affected by water damage were secured.
V. Estimated Cost of Damage
|
Item |
Estimated Cost |
|---|---|
|
Server Rack and Equipment |
$75,000 |
|
Water Damage to Office Furniture |
$20,000 |
|
Repair and Cleanup Costs |
$10,000 |
|
Lost Productivity |
$5,000 |
|
Total Estimated Damage |
$110,000 |
VI. Witnesses
-
Ena Cassin – IT Manager, (ena@you.mail)
-
Lowell Quizon – Facilities Supervisor, (lowell@you.mail)
VII. Attached Documents
-
Photos of the damage
-
Repair estimates from local IT services
-
Fire department incident report
-
Cleanup service invoice
VIII. Additional Notes
IT recovery is in progress with all critical data being restored from backup. Preventive measures, such as fire suppression systems, are being implemented to avoid similar incidents in the future.
