Hand Receipt Form For Temporary Use/off-Campus Use Of Equipment

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Hand Receipt Form

for Temporary Use/Off-Campus Use of Equipment

Receiving & Property Control

Phone: 662-325-2545

Fax:

662-325-4551

Mail Stop 9605

This form should be completed any time equipment is removed from the department premises for any reason and for any length of time. It is only

valid if completed in its entirety and updated every twelve months from the date at the top of the form. The department is responsible for maintaining

this form and providing a copy to Receiving & Property Control. Further, it should be made available upon request for any reason.

Click Here for Detailed Instructions

This form prepared by:

Name:___________________________________________ Phone: _____________________________ Date: ___________________________

Dept. Inventory

Dept Id: ___________

Dept Name: __________________________________________

Representative:____________________________

Inventory

Number

Item Description

Serial Number

Cost/Value

Additional items may be listed in an attachment to this form.

This is to verify that I have the equipment listed above and that I am using it to complete official departmental business. I accept full responsibility for the

equipment while entrusted to my care and will return the equipment when any of the following conditions occur: (1) when the equipment

is no longer needed for official departmental business; (2) at the request of the department head, dean, director, vice president or

Property Officer; (3) at the end of my employment with the department.

Typed Employee's Name

Employee's Signature

Date

Expected Return Date

This section is to be completed by the Departmental Inventory Representative or Department Head

I have visually seen and inspected the equipment listed above upon the

issuance

renewal of this form. (Please mark the appropriate action.)

Department Inventory Representative/Department Head