School Facilities Equipment Checkout Form printable pdf download

SCHOOL FACILITIES

05.33 AP.2

Equipment Checkout Form

MPLOYEES SHALL COMPLETE A SEPARATE FORM FOR EACH ITEM

ISTRICT PROPERTY THAT IS TO BE TAKEN OFF

SITE

• All property on loan from the District shall be documented via this form, which shall be kept

on file by the Principal or Director of the school/department that has ownership of the

property.

• Any items that are checked out shall be reported to the Principal or Director to ensure it is

included the physical inventory for the current school year.

• A copy of all assets on loan shall be summarized into one (1) file by the Principal, Director

or designee and forwarded to the Purchasing Supervisor and copied to the Auditor by

September 30 of each year and updated as items are returned or loaned.

Today’s Date: ____________________

Date Checked Out: ____________________

Date of Expected Return: _______________

Property Description/Type: ______________________________________________________

_____________________________________________________________________________

Serial # & Tag #: _____________________________________

Estimated Age of Equipment: _______________ Estimated Cost (if known): ______________

Assigned School or Location of Equipment: _________________________________________

Room/Room Number: _______________________ Supervisor’s Name: ___________________

o

Is item greater than $1,000 in values?

Yes

NDERSTANDINGS

• I understand that if the equipment is lost, stolen, missing or damaged, I may be required to

pay the amount for replacement or current insurance deductible, whichever is less.

• I further understand that if the equipment is lost, stolen, missing or damaged outside of work,

I must file a claim with my insurance provider first. If that claim is denied, then I may file

claim with the District insurance carrier.

• I understand that by checking out this equipment that I am fully responsible for its return.

_____________________________________________________

__________________

Printed name/Signature of Employee Checking Out Item

Date

_____________________________________________________

__________________

Printed name/Signature of Employee Authorizing the Loan

Date

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School Facilities Equipment Checkout Form