Appendix6. Incident Report Template
Location (District/sector/cell):
Date (Day/Month/Year/time if possible):
Damaged Infrastructure:
Owner of Infrastructure:
Source of incident:
Responsible for Damage:
Damage Severity:
Critical
Major
Medium
minor
Affected sites (clients):
Immediate Solution:
Recommendations for the Permanent
solution:
Owner’s Comment :
(Affected Institution Representative )
Responsible Comment:
(Source of the Damage)
Prepared by:
Approved by Name:
Name:
………………………………………………….
Name: ………………………………………………….
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