I have been advised by [insert name and job title of relevant person] that the [insert
description of electrical item/s] I have brought onto University premises are prohibited
and/or dangerous in terms of electrical safety and/or fire safety.
The [insert description / photograph of electrical item/s] have been returned to me for
removal from the University.
I agree not to use the [insert description of electrical item/s] while on University
premises.
Signed: ..........................................................
Name: ..........................................................
(please use capitals)
Department / Section / Business Unit / Company:
......................................................................
(please use capitals)
Date: ..........................................................