Loss Damage Waiver Incident Report

Should the Lessee encounter an event that results in damage in excess of the deductible, or total loss of the trailer that is scheduled in the Lessor’s Loss Damage Waiver program (LDW), the Lessor requires that an approved representative of the Lessee complete this Incident Report and submit it to the Lessor within 48 hours of the damage/loss event.

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Lessee/Customer Contact Name
Must be an authorized company representative
Driver Name
What is the lessee/customer's relationship to the driver?*
Date / Time
Incident Location
Were there injuries or fatalities?
Were any other vehicles involved in this incident?
Was damage caused by an over-the-road breakdown?
Is the equipment loaded?
Did the equipment contain hazardous materials at the time of the incident?
Does the equipment require a tow?
Current Location of Equipment
Was the equipment towed to the current location?
Is the trailer secure within the lessee's (your) control?
Is the equipment physically on one of your properties
Do you have a copy of the police report?
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