Windshield/Glass Loss Report

WINDSHIELD/GLASS LOSS REPORT

Please complete this form only for windshield/glass damage. If there is body damage please complete the Vehicle Accident Report.

Date of Loss

Location of Vehicle

Driver's Name

Department Contact

Department Phone Number

Vehicle License Plate

Vehicle Year/Make/Model

VIN#

Workday Account Program Number

Is the a Motor Pool Vehicle?

Yes No

Briefly explain what happened:

After submitting this loss report, please email three (3) bids to BCNRisk@unr.edu prior to repairing the damage. After review our office will contact you with further information.

Please see list of preferred vendors here: http://risk.nv.gov/LP/Windshield/