Component and Property Damage Notification

If this situation requires additional attention please call Landwehr Construction’s Safety AND COMPLIANCE DIRECTOR at 320-248-7164

Complete this form following any component or property damage.

LCI Division(Required)

Name of Rigger or Operator(Required)

First Last

Date(Required)

Job #(Required)

Project(Required)

List ALL LANDWEHR Employees Involved(Required)

Component Serial #(Required)

Component Type(Required)

Equipment #(Required)

Description of Damage(Required)

Cause of Damage(Required)

Describe How Damage Could Have Been Avoided(Required)

Signature(Required)

Date(Required)

CAPTCHA