Employee Equipment Acknowledgement Form
Please complete this form to acknowledge receipt and responsibility for company-issued equipment.
Employee Full Name
*
First Name
Last Name
Employee ID
*
Department
*
Contact Email
*
example@example.com
Equipment Description
*
Equipment Serial or Asset Number
*
Equipment Condition at Issue
*
Please Select
New
Good
Fair
Needs Repair
Date Issued
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Expected Return Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
I acknowledge receipt of the listed equipment and accept responsibility for its care, return, and reporting any issues.
*
Submit
Submit
Should be Empty: