Page 118 - New Hire Orientation Packet 6.17

EMPLOYEE EQUIPMENT CHECK-OUT LIST

Employee Name: Department: Title:

I acknowledge that I received the equipment described below and that I am responsible for the
proper use and return of the equipment. I am aware that I must inform the HR department should
any of the equipment listed below become damaged, lost, or stolen. Further, I acknowledge that I
may be held financially responsible for the replacement of the equipment below should the
equipment become damaged or lost due to my negligence.

Signature

Site Where
Equipment Equipment is Employee Issuer
Issued Located Issued by Date Issued Initials Initials
(if applicable)

www.ebaldc.org  1825 San Pablo Ave, Suite #200, Oakland, CA 94612  Phone: (510) 287-5353  Fax: (510) 763-4143