Certificate of Destruction Form
Complete this form to document the destruction of items or materials for operational recordkeeping.
Certificate Number
*
Date of Destruction
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Description of Items/Materials Destroyed
*
Quantity Destroyed
*
Method of Destruction
*
Please Select
Shredding
Incineration
Crushing
Chemical Treatment
Other
Reason for Destruction
*
Please Select
End of Life
Defective
Obsolete
Confidential Data
Other
Location of Destruction
*
Responsible Party Name
*
First Name
Last Name
Witness or Supervisor Name
*
First Name
Last Name
Additional Notes or Reference (optional)
Submit
Should be Empty: