LSU Property Claim Reporting Form

Department Information

Department Name

Please enter the department from which this claim was filed.

Department Cost Center

Department Program Account

Department Contact

Please enter the first and last name of the person filing the claim.

Department Contact E-mail

Department Phone

Secondary Department Contact

Optional - i.e. Business Manager, Building Coordinator, Department Head

Secondary Department Contact Email

Loss Location Information

Date of Loss

mm/dd/yyyy

Time of Loss

Please select the approximate time the claim occurred. 24:00 is midnight; 12:00 is 12:00 PM; 00:15 is 12:15 AM.

Building Name

If you need to look up your building name, map number, and/or FAC number, please follow this link: http://lsu-gis.lsu.edu/. If a loss occurred to an inventory item outside of a building then please select the building for which the inventory item in assigned in Workday.

Building FAC/FAMIS#

On or off-campus?

Room #

Address

City

State

Zip

Loss Description Information

Cause of Loss

Please select option that best describes the cause of the damage.

Description of Loss

Please use this field to provide how the incident occurred.

Please use the attachment field to include photos, equipment inventory records, and other related documents.

Drop your files here

Applicable Facility Service's Work Order Number(s)

Departmental Estimated Cost

Estimated Cost

Please provide an estimated cost of replacing or repairing damaged equipment/property. Your estimate will not impact your claim, it will simply be used to assist Risk Management in the budgeting process.

Police Report Filed

In order to receive a copy of this report you must click the box below indicating "Send me a copy of my response".

If you have any questions, please contact the Office of Risk Management at 578-3283.

Data Authorization

I authorize that all information provided on this form, including any and all personal, financial and academic data may be shared with the LSU Risk Management and university insurance carriers and vendors. This data will be securely retained indefinitely. To learn more about privacy at LSU, please see the LSU Privacy Statement.

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