Granite School District – Technology Equipment Checkout Form
Compliance Statement for Loan of Technology Equipment
Condition 1
Technology equipment can only be loaned during the days school is not in session and to employees of the
Granite School District and/or those designated by the school principal as adults directly affiliated with on-
going school programs. Such loaned equipment is to be kept in the possession of said designee and can be
used only by said designee for assigned academic study/practice and not for private pursuits.
Condition 2
The designee (hereafter termed “borrower”) is totally liable for all lost and/or damaged technology equipment
while in his/her possession; this also applies to the transporting of loaned equipment between the school and
the home of the borrower.
Condition 3
District-owned technology equipment may be loaned only for the period designated on this form. This
equipment must be returned on or before the assigned date.
Dated Loaned: _________________ Date Due: _________________ Date Returned: _________________
Condition 4
Equipment identification requires the following information before the equipment can be loaned.
Item
Manufacturer
Serial Number
Fixed Asset No.
Condition 5
Borrower must supply the following information:
A. Name: ________________________________ Telephone Number: __________________________
B. Permanent Address: _________________________________________________________________
City: ________________________________________________ ZIP Code: _____________________
C. Granite District Assignment: ________________________ Location: __________________________
D. Borrower must sign this form as designated, signifying his/her intent to conform to all “conditions”
outlined above on this form.
Signature of Borrower: _________________________________________________ Date: ____________
Approved By: ________________________________________________________ Date: ____________
Position of Approving Authority: __________________________________________________________
5/25/2012