Equipment Check Out Form printable pdf download

Equipment Check Out Form

2016-17 ITC Equipment Checkout Form

Name:

Phone:

Winthrop Email:

_____________ Winthrop ID Number

Faculty/Staff

Student

Date of Reservation:__ _

/____

Course/ Department and Purpose of Checkout:______________________________________

I understand that I am responsible for all equipment that is checked out in my name and fully understand and

agree to adhere to the ITC equipment check out policies located on the ITC web site.

I understand these items are my responsibility. I share the responsibility with the ITC Student Workers to check

these items before taking them from the ITC, before bringing them back to the ITC, and when I return them to

the ITC to make sure nothing is missing or damaged. I can use the checklists below to make sure all items are

returned and in good working order. I understand that all bags with many parts also have a laminated card that

illustrates what those pieces look like to help me keep track of them and that this should also be returned with

the equipment at check in.

To Be Picked Up On:

Signature at check out:

Date:

To Be Returned On:

Signature at check in:

Date:

ITC Staff Only – Complete Below – be sure to include any extra cables or items

INVENTORY NUMBER

EQUIPMENT TYPE AND QUANTITY

(or list as non- inventory item)

Checked out by:_________________________ Date: ______________ # of items______________

Checked in by:__________________________ Date: ______________ # of items______________

Overdue notice:

2 days past due ____/____/____

5 days past due ____/____/____ 10 days past due ___/____/_____

Date billed to patron account:

Amount billed:

Equipment Check Out Form