物品丢失和安全事件报告

物品丢失和安全事件报告 Loss & Incident Report Claim No. 索赔编号: 物品丢失和安全事件报告 Report No 报告编号: 任何有关涉及酒店员工、客人或任何财产的伤害和安全事故均以此格通过邮件: 或传真: 形式报告给集团风险管理部，如果您的保险不包含在本集团 项目内,另需给当地保险索赔办公室抄送一份复印件。 General Liability 一般责任 Hotel Property 酒店财产 Hotel Crime 酒店犯罪 Hotel Name 酒店名称: Location No 酒店位置. Street Address 街道地址: City 城市: State/ Province/ Country 省/市/国家: Phone No 电话号码.: Postal Code 邮政编码: General Manager 总经理: E-mail Address 电子邮箱: Name of person involved 有关人员姓名: Was person involved a hotel guest, invitee, vendor or other? 涉及人员是否包括酒店住店客人，或被邀请客户、供应商或其他人 Street Address 街道地址: 邮政编码: Postal Code City 城市 State/ Province/ Country省/市/国家: Date of Birth 出生日期: Gender 性别: Home Phone No 宅电.:家庭电话 Work Phone No 工作电话.: Check-in Date 入住日期: Check-out Date 离店日期: Is this person making a claim 当事人是否要求赔偿 : Room No 房号.: Yes 是 No 否 Date of Incident 事故发生日期: Time of Incident 事故发生时间: Location of incident (Where on the property?) 事故发生地点/具体酒店地点: Type of Incident (Slip/Fall, Room Theft, Illness, etc.) 事故类型 (滑倒/摔倒，房间失窃，生病等): Cause of Incident 事发原因: Did an injury occur 有否事故伤害: Yes 是 No 否 N/A 不确定 事故描述:1)具体细节; 2)描述事故发生 (何时，何处，何人及如何发生): 3) 确定所有相关涉及人员并列出所有目击证人名单和地址 4)如系盗窃，请列出物品估算价格及具体描述 Action taken by hotel 酒店处理结果: Amount of property loss/ damage (estimate) 遗失/损坏物品价格(估算): Yes 是 No 否 N/A 未确定 Medical assistance rendered by hotel 酒店提供医疗协助 : Report No 报告于.: Police or Fire department contacted 联系警方或消防部门: Yes 是 No 否 N/A 未确定 Information was reported to (Name of employee)已汇报给(员工姓名): Position 职位: Information was reported by (guest, employee, etc.) 汇报者 (客人，员工等): Yes 是 No 否 N/A 未确定 Was car valet parked? 酒店是否提供泊车服务? Yes 是 No 否 N/A 未确定 Were liability signs posted? 事故责任提醒牌是否张贴? Describe 描述:Were there signs of forced entry? 有否任何被强行进入迹象? Were locks interrogated? (Attach Report) Yes 是 No 否 N/A 未确定 放门锁有否被撬? (附报告) Results of interrogation 审问结果: Yes 是 No 否 N/A 未确定 Was housekeeping questioned? 客房部员工是否被查问, Results of questioning 查问结果 Witness name 证人姓名: Phone no. 联系电话: Address 联系地址: Witness name 证人姓名: Phone no.联系电话: Address 联系地址: Comments 注释: Report Completed By 填表人: Title 职位: Date of Report 报告日期: Report Reviewed by GM 总经理审阅报告? Yes 是 No 否 N/A 未确定