SOP 401.07-att-1: Georgia Department of Corrections Claim of Loss Form

Division:
Executive
Effective Date:
February 11, 2022
Reference Code:
IVA01-0008
Topic Area:
401 Policy-OPD, Care and Custody
PowerDMS:
View on PowerDMS
Length:
84 words

Summary

This form is used by GDC employees to document and submit claims for lost, damaged, or stolen personal property or equipment. Employees complete the form with details about the lost item, its replacement or repair cost, and the circumstances of the loss. The form requires signatures from the employee, care and custody manager, regional business manager or director of administration, and warden or superintendent for approval and processing.

Key Topics

  • claim of loss
  • employee claim
  • property loss
  • damage claim
  • loss form
  • reimbursement
  • damaged property
  • stolen property
  • claim submission
  • expense reimbursement
  • GDC employee
  • facility claim

Full Text

401.07
Attachment 1

02/11/22

Georgia Department of Corrections Claim of Loss

Employee: _____________________________________________________________________
Facility: _______________________________________________________________________
Address: _______________________________________________________________________
Report: ________________________________________________________________________
Date of Occurrence: ______________________________________________________________
Position Number: ________________________________________________________________
Employee ID Number: ____________________________________________________________

|Description of Item|Col2|Replacement Value
OR
Repair Cost|
|---|---|---|
|
|
||
|
|
||
|
|
||
|
|
||
|
|
||
|
|Total Amount of Claim||
|
|Approved Claim Amount||

Description of Cause or Action for Claim: ___________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

|Employee Signature:|Care & Custody Manager:|
|---|---|
|Regional Business Mgr./ DW of Admin.
Signature:|Budget Code:|
|Warden/Supt. Signature:|Acct. Code:|

Retention Schedule: Upon completion, this form and any receipts pertaining to this procedure shall be retained for
five (5) years.

Attachments (1)

  1. Georgia Department of Corrections Claim of Loss Form (84 words)
Machine-readable: JSON Plain Text