Equipment Issued. Asset ID Number Tag Number Project Number Asset Description Date Issued Employee’s Initials for Issuance Return Date Employee’s Initials for Return Coordinator’s Initials for Return Note: • These items must be tagged before going off campus • A copy of this form must be kept on file within the organization or department and provided to HR promptly (and no later than 25 days after the employee’s resignation or termination) so that payroll/vacation account deductions may be made. • A copy of this form must be submitted to the appropriate business unit office.
Equipment Issued. One (1) Chromebook • One (1) Chromebook charger • One (1) Protective case Replacement Value: • Chromebook $448.00 • Chromebook Charger $34.00 • Protective Case $30.00 By signing below, you are indicating that you have read and agree to all of the above terms. Student Name (printed): Student Signature: Date: Parent/Guardian Name (printed): Parent/Guardian Signature: Date: Office Use Only: Chromebook Assignment District Serial Number: Staff Initial
Equipment Issued. One (1) Apple iPad • One iPad charger • One iPad charging cord • One Protective case By signing below, you are indicating that you have read and agree to all the above terms. AGREED: Student Name (printed): Student Signature: Date Parent/Guardian Name (printed):
Equipment Issued. All department issued and authorized equipment shall be inspected as described in Chapter 53 of this Manual of Standards.
Equipment Issued. One (1) Apple iPad • One iPad charger • One iPad charging cord • One Protective case Replacement Value: • iPad $ 329.00 • iPad charger $ 19.00 • iPad charging cord $ 19.00 • Protective case $ 40.00 By signing below, you are indicating that you have read and agree to all of the above terms. AGREED: Student Name (printed): Student Signature: Date Parent/Guardian Name (printed):
Equipment Issued. ❑ Hardhat ❑ Safety Glasses ❑ Reflective Safety Vest ❑ Fall Protection Harness & Lanyard ❑ Respirator ❑ Other To be completed by supervisor in the field with the employee ❑ Show employee around the project and discuss potential hazards ❑ Introduce employee to crew members ❑ Assign new employee to experienced work crew ❑ Specify work duties ❑ Where to eat lunch This is to acknowledge that I have completed new employee orientation and understand that failure to comply with the Safety Program may be grounds for dismissal.
Equipment Issued
