Equipment Liability Form

The following acknowledgment form has been created to highlight the procedures for equipment signed out to BEAT AIDS employees. Please note is one form per device.

I understand that I am responsible for any and all fees if my equipment is lost, stolen or broken. You agree to pay the original cost of the item.

I must report any damages done to the equipment within 24 hours.

I understand that under no circumstance should I leave my equipment unattended as it may contain confidential information.

I understand that at no time I am allowed to download any applications unless approved by the Department Director.

I understand that if I am terminated or resign and I do not return all equipment I consent to get the retail price deducted.

I Your Name*, have received the above instructions and an internal training covering the care of equipment and the usage of my assigned electronic device.

Device Brand

Device Model / Generation (Tablets)

Device Model can be HP Pavilion, Dell OptiPlex, Dell Latitude, Apple iPad, Apple iPhone, etc.

Equipment Type

mobile phones/tablets, laptops, desktops, monitors, printers, credit card readers and locks

Serial Number

Date Received

Date

Passcode (ONLY for iPads/Square Machines)

Date Returned

OFFICE USE ONLY

Employee Signature

Email

example@example.com

Employee Name

Supervisor

First NameLast Name

Supervisor

Notes

Take Photo of Device Serial Number (This option is only if you are using a phone to submit this form)

Does your device have a label with "PROPERTY OF BEAT AIDS" + "Serial Number / Device ID"