Cdspi Office Inventory And Valuation Form

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OFFICE INVENTORY AND VA LUATION FORM
Please use this form to maintain a cu r re nt re co rd of the co nte nts of your office and
their re p l a ce m e nt va l u e s, for insura n ce purposes. To be fully insure d, the face va l u e
of your office insura n ce policy should equal the total re p l a ce m e nt cost for all yo u r
o f f i ce co nte nt s. If you have more than one dental office, use a separate form for
N AM E
each locat i o n .
If you ever need to make a claim under the Of f i ce Co nte nts portion of yo u r
Tr i p l e G u a rd
TM
I n s u ra n ce, this re co rd will be of gre at assistance. The onus is on you to
p rovide the insura n ce co m p a ny with both a co m p l e te list of the pro p e rty destroye d
OFFICE LO CAT I O N
or damaged and an estimate of its re p l a ce m e nt co s t. Unless you have pre p a red a
t h o rough inve nto ry before h a n d, you may find the task ve ry difficu l t.
You are urg e d, there f o re, to co m p l e te this inve nto ry and va l u ation and update the
DATE FORM CO M P L E T E D
form re g u l a r l y. Sto re the form in a safe place outside your office, such as a safety
deposit box. The time you spend now may save you hours of inco nve n i e n ce and
h u n d reds of dollars, late r.
1. OPERATORIES
2. LABORATORY
#
UNIT REPLACEMENT
CURRENT TOTAL
#
UNIT REPLACEMENT
CURRENT TOTAL
ITEM
ITEM
COST
REPLACEMENT COST
COST
REPLACEMENT COST
Dental Chair(s)
Benches
Operating Units (including
Burnout Oven
air driven hand pieces)
Casting & Soldering Bench
Amalgamators
Electric Welder
Individual Hand Pieces
Model Trimmer
Sterilizers
Polishing Lathe & Hood
Autoclaves
Cabinets
Compressor(s)
Other
Cabinets
Other
Articulators
Operating Lights
TOTAL #2
Assistant Stool(s)
3. BUSINESS OFFICE & RECEPTION AREA
Operating Stool(s)
#
UNIT REPLACEMENT
CURRENT TOTAL
ITEM
Oral Evacuator System
COST
REPLACEMENT COST
Pneumatic Condenser
Desks
Nitrous Sedation Unit
Tables
Hand Instruments
Chairs
Hydrocolloid Conditioner
Couches
Misc. Oper. Room Supplies
Typewriters
Intra Oral Camera
Computer Hardware &
Filling Material & Supplies
Software
Misc. Surgical Supplies
Adding Machines
Prosthetic Supplies
Photocopier
Prosthetic Accessories
Filing Cabinets
X-ray Processors
Stationery Supplies
Developing Equipment
Carpets
X-ray Supplies
Lamps
Other X-ray Equipment
Drapes
Other
Sound System
Other
Pictures & Ornaments
Other
TOTAL #1
Other
TOTAL #3

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