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
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: __________________________________________
Item Description
Serial Number
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
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
renewal of this form. (Please mark the appropriate action.)
Department Inventory Representative/Department Head
Phone Number
Return of Equipment Verification
Employee's Signature
Department Property Representative/Department Head
Return Date
Property Control Use Only:
Agency __________ Trans Code ______ Report No___________ Month Year __________ Initial ___________ Date _________________
Original - Departmental File
Copy - Receiving and Property Control
RPC-MSC03 Hand Receipt Form 01/08
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