Uniform Return Checklist Form
Complete this Uniform Return Checklist Form to document the return and condition of all issued uniform items.
Full Name of Person Returning Uniform
*
First Name
Last Name
Department or Unit
*
Date of Return
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Uniform Items Returned (Check all that apply)
*
Shirt
Pants
Jacket
Belt
Hat/Cap
Shoes/Boots
Other
Quantity of Each Item Returned
*
Rows
Quantity
Shirt
Pants
Jacket
Belt
Hat/Cap
Shoes/Boots
Other
Condition of Returned Items
*
Rows
Excellent
Good
Fair
Poor
Shirt
1
2
3
4
Pants
5
6
7
8
Jacket
9
10
11
12
Belt
13
14
15
16
Hat/Cap
17
18
19
20
Shoes/Boots
21
22
23
24
Other
25
26
27
28
List Any Missing Items
List Any Damaged Items
Additional Comments or Notes
Return Confirmation (Type your name to confirm all information above is accurate)
*
Submit
Should be Empty: