SOP_NUMBER: 401.07-att-1
TITLE: Georgia Department of Corrections Claim of Loss Form
REFERENCE_CODE: IVA01-0008
DIVISION: Executive
TOPIC_AREA: 401 Policy-OPD, Care and Custody
EFFECTIVE_DATE: 2022-02-11
WORD_COUNT: 84
POWERDMS_URL: https://public.powerdms.com/GADOC/documents/105434
URL: https://gps.press/sop-data/401.07-att-1/

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

ATTACHMENTS:
  1. Georgia Department of Corrections Claim of Loss Form
     URL: https://gps.press/sop-data/401.07-att-1/

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FULL TEXT:
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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<br>OR<br>Repair Cost|
|---|---|---|
|<br>|<br>||
|<br>|<br>||
|<br>|<br>||
|<br>|<br>||
|<br>|<br>||
|<br>|Total Amount of Claim||
|<br>|Approved Claim Amount||



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







|Employee Signature:|Care & Custody Manager:|
|---|---|
|Regional Business Mgr./ DW of Admin.<br>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.