Equipment Request Form
Please note that all requests take a minimum of one week to process. This form is not for new starters.
Name
Project
Category
SLA
Requesters First Name
*
Requesters Last Name
*
Requesters Contact Number
*
Please enter a valid phone number.
Requesters email addresss
*
firstname.surname@birminghamhospice.org.uk
Equipment Requirements
Reason for equipment?
*
Addition to Role
Work station setup
Wear & Tear
Theft
What equipment do you need?
Please choose equipment required
*
Please Select
Apple Accessories
DSE - Keyboard
DSE - Mouse
DSE - Supportive Chair
Docking Station
Headphones
Keyboard
Laptop
Laptop Bag
Laptop Trolly
Mobile Phone
Mobile Phone Charger
Monitor
Mouse
Power Supplies
Smartcard Reader
Web Cam
Please specify the reason for the equipment request
*
Request Date and Time for the equipment to be delivered:
*
Where is. the equipment needed?
*
Erdington
Selly Park
Remote/Home Setup
Retail Shop
Retail shop address:
1st Line of your address:
*
House/ Apt Number and Street Name
City:
*
Which City is this?
Postcode:
*
Whats the postcode
Employee Details
(Enter the details of the person receiving the equipment)
Name
*
First Name
Last Name
Role
*
Department
*
Line Managers Details
(Enter the details of the person who line manages the Employee receiving the equipment)
Line Managers Name
*
First Name
Last Name
Date
Line Manager Email address:
*
firstname.surname@birminghamhospice.org.uk
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