InTouch EDC Tracker
Please Complete this Form and upload the completed FLEX Pullsheet/Return Below
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Employee Name
*
First Name
Last Name
Employee E-mail
*
example@example.com
Employee Phone Number
Format: (000) 000-0000.
Account Manager Name & Event / Program Code
*
Inbound / Outbound
*
Please Select
Inbound (Received / Returned from Event)
Outbound (Shipped / Pulled for Event)
Please Complete Inbound and Outbound Separately
Tracking #'s
Asset ID #'s & Qtys
Rows
EDC#
"Q739..."
w/EDC Charger
BATT#
"BT..."
w/Battery Charger
STAND#
"Fuji..."
#1
#2
#3
#4
#5
#6
#7
#8
Secondary Equipment
*
Document Envelope
Keyboard
Powerstrip
NONE
Other
Notes / Comments
Conditions/Damages, Location of Return Paperwork / Special Instructions
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Should be Empty: