 Used to request permission to remove parts from an
existing piece of inventory
 Assumes that the original equipment is being removed
from the departmental inventory
 After removal of all usable parts, remaining “shell”
should be transferred to Surplus with copy of approved
cannibalization form attached
 Leaving unusable equipment on departmental
inventory exposes UTSA to potential loss that would
be reported at original cost
THE UNIVERSITY OF TEXAS AT SAN ANTONIO
INVENTORY DEPARTMENT
EQUIPMENT CANNIBALIZATION REQUEST FORM
This form is used to request authorization to remove parts from an obsolete piece of equipment being turned-in to Surplus.
INSTRUCTIONS: Please: 1) Complete this form and retain a copy for your records.
2) Submit the completed original form to the Capital Asset Manager (CAM) in the Inventory Department.
3) Attach this form to the Surplus Turn-In Form, if applicable.
4) A signed copy will be sent back to you with the CAM approval signature.
Department ___________________________________ Unit Code ___________________ Date _______________ Phone Ext. __________
Inventory Contact Person (ICP) (print name) ______________________________Signature_________________________________________
(Appointed Individual)
REQUEST APPROVAL TO CANNIBALIZE EQUIPMENT LISTED BELOW:
UTSA TAG #
BAR CODE #
SERIAL #
DESCRIPTION OF ITEM
JUSTIFICATION FOR CANNIBALIZATION (this section MUST be completed):
ITEM COST
LOCATION
BUILDING
ROOM #
Inventory Manager’s Review
_______ Create spare part(s) for equipment in this department for _____________________________________________________________________
_______ Equipment is beyond economical repair, but still has usable parts for ____________________________________________________________
_______ Part(s) will be added to existing equipment barcode/Tag ID #__________ __________ __________ _________ __________ ___________
_______ Part(s) removed from a Vehicle _________________________________________________________________________________________
_______ Other (explain) ______________________________________________________________________________________________________
______________________________________________________________________________________________________
REQUIRED SIGNATURES
Authorized Departmental Official/Chair: ____________________________________________ Signature: __________________________________________________
(Print name)
Capital Asset Manager: ______________________________________ Signature: ______________________________________ Date: _____________________
(Print name)
Please contact the UTSA Inventory Department for assistance: ext. 4830, 4835, 6131, 6395, or 6396.
Revised by: C. Porter
11/27/2006
 Removal/Transfer of Hard Drive
 Be cognizant of risks associated with data remaining on
cannibalized hard drive
 Unless being used in same department, software
licenses on cannibalized hard drives should be removed
or hard drive should be wiped using available software
packages (not just deleted)
 Departments are responsible for data on their
equipment, regardless of whether actively in use or
stored.
 Computers sent to Surplus have hard drives drilled prior
to transfer from UTSA
 No cost to departments to turn in obsolete equipment
 Removes capital and controlled items from your
departmental list of inventory
 Protects department from lost or stolen equipment left
in closets, storage rooms, etc.
 Check-box asks if any parts have been cannibalized,
primarily to determine condition of equipment for
potential reuse at UTSA or sale at auction
UTSA
Date: (mm/dd/yyyy)
/
/
The University of Texas at San Antonio ● Surplus Department
Surplus Property Turn-In Form
Enter your department’s 7-digit Unit Code. Obtain the unit code from your departmental Inventory Contact Person (ICP). Enter the date this form is prepared.
Enter departmental information, location where property is to be picked up from, and the contact information.
For Capitalized/Controlled property that has UTSA Tags and or Barcodes, etc., fill out a separate line item for each tag/barc ode. For non-tagged/barcoded items, i.e.
desks, enter “Desk” under Item Description and the Quantity.
4. Obtain Department Head signature and send the ORIGINAL signed form to the “Surplus Department” through campus mail, faxed forms will not be accepted.
Incomplete/incorrect forms will be returned to the department for correction. For assistance with preparing this form, call 4 58-6282.
2. Submitting Department: (Please, No Abbreviations)
Department Title:
Contact Name:
Contact Phone:
Instructions:
Campus:
1604
1.
2.
3.
Building:
DT
ITC
Room #:
Univ Hts
3. Property Information:
Old UTSA
Tag # :
New UTSA
Barcode # :
Serial # :
Qty:
Item Description:
Brand:
Item
Works ?
Model:
Y
Check here if parts from the above
items have been cannibalized. Attach
all copies of cannibalization forms to
this form.
4. Request/Approval/Acceptance:
Printed
Department Head
Name:
Approval:
Signature:
Unit Cost
(Each):
Surplus Use Only:
N
1
Items that contain or have once contained hazardous materials (i.e. biological, radioactive, corrosives,
flammables, asbestos, chemicals, etc.) must be inspected & cleared by the Environmental Health, Safety & Risk
Management office prior to Surplus turn-in. Call 458-6101 to request an inspection, attach a copy of inspection
clearance results to this form. For disposal of batteries and toner/ink cartridges call 458-6698 for pick-up.
2
3
Continuation Sheets Attached:
Yes
No
Number of continuation sheets:
Title:
Surplus Internal Use / Audit
Date:
5. Surplus Use Only:
Capital Asset Manager:
Site Contact:
Property Transfer Verification:
Received by Surplus Rep:
Print Name:
4
Date:
Customer Copy
Date:
Accepted
Declined
Date:
Customer
Initials:
Surplus Rep
Initials:
Sign:
This form must be TYPED, handwritten forms will not be accepted.
This form must be TYPED, handwritten forms will not be accepted.
1. Unit Code (7 Digits):
 No guarantee of future funds for this purpose
 If funds are made available, replacements will be based on
following criteria:
 Between X & Y number of years old
 One computer surplused for each new computer received
 All parts intact (bootable)
 Been on UTSA network during last 60 days
 Holding onto unused equipment is risky, as same
responsibility for loss exists
 Take advantage of Surplus process - reduce time spent on
annual inventory and reduce risk of loss