Employee Equipment Liability Form
Complete this form to acknowledge receipt and responsibility for company equipment.
Full Name
*
First Name
Last Name
Department
*
Job Title
*
Equipment Name/Type
*
Equipment Serial Number (if applicable)
Date Issued
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Condition of Equipment at Issuance
*
Please Select
New
Good
Fair
Used
Additional Notes (optional)
Employee Signature
*
Submit
Submit
Should be Empty: