Purpose: The purpose of this form is to provide the agencies with a standardized form for loaning equipment to employees, other agencies, municipalities, etc. If an agency currently has its own form it should be reviewed to compare the data on this standardized form.
The date this agreement is entered into.
Each agency should assign its own number to the form.
Individual that is entered into this agreement.
Enter Room Number where the equipment is normally located.
Agency address where the equipment is normally located.
Building number, if known.
Indicate the inventory tag number assigned to the property.
Indicate the manufacturer's serial number, if applicable.
Enter a brief description of the item and its current condition.
Enter the current cost or value of the item as indicated on the agency inventory records.
Usage of the Property
Indicate what the property will be used for.
Indicate the specific unit of the agency that is borrowing the property.
Enter your agency's name.
Location of the Property
Give the complete address of where the property will be located.
Date of Return
Indicate the date the property will be returned to the agency.
Approved Director or Department Head Signature
Signature of the director or the department head.
Please print the name of the person that is approved to sign the release of the equipment.
Signature of the individual that is borrowing the property.
Please PRINT the name of the individual that is borrowing the property.
Indicate the date that the property is actually returned to its location.
Building No. and Room No.
Enter the building number and the room number that the equipment was returned.
Please Note Any Exceptions
Please indicate any exceptions to the equipment upon its return for future reference.
Director or Department Head Signature
Signature of the director or department head of the unit that maintains the property.
Follow this hyperlink for an example of this form.
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