Equipment Loan Agreement
This form must be completed whenever equipment is loaned to Yale University School of Medicine faculty or staff. A copy of
this form must be placed in both the departmental equipment inventory file, and the departmental personnel file.
The following equipment was loaned to (name and title) ________________________________________
on (date) __________________________________
This equipment must be returned by _______________________________________________
Purpose of Equipment Loan:
Description of Equipment:
New Location of Equipment: _____________________________________________________
Equipment Purchase Date and Price: ________________________________________________
Equipment Serial Number:________________________________________________________
Yale Equipment Tag Number: _____________________________________________________
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I understand that the equipment described above is the property of Yale University School of Medicine, and is on loan to me
from the University. I certify that this equipment will be used exclusively in my capacity as an employee of the University. I
agree to return the equipment to the University in accordance with the terms specified above or upon termination of my
employment, which ever occurs first. I further understand that I must report to the University any loss or damage to the
equipment immediately upon occurrence, and that the University reserves the right to require immediate return of the equipment
at any time.
Required Signatures:
Borrower ____________________________________________ Date: ___________________
Department Administrator ________________________________ Date: ___________________