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NEW BEGINNINGS CHURCH
WINNIPEG, MB,
CANADA
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Date of Report
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required
Incident Date
*
required
Time of Incident
Occasion/Event Name:
Renter's Full Name/Organization:
Primary Contact Person: Full Name
Contact Phone:
Contact Email
1. Location of Damage:
Room/Area
Specific Location within Room/Area
2. Description of Damage
Type of Incident:
Structural (walls, floors, ceilings)
Furniture (chairs, tables, etc.)
Equipment (sound system. kitchen appliences, etc.)
Fixtures (lights, doors, windows, etc.)
Other:
Detailed Description of Damage
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