Uploaded by AIX Abdennour


Organisation: nourdez
Project: Your First Project
Team: Your First Team
Template ID: DP-PEA-0012
Template Version: 2
Form Version: 1
Equipment Responsibility Form
nour dz
Created Wed, 06 Apr 2022, 10:44 AM (UTC+01)
I acknowledge that I have received the following equipment for use in my work area.
I understand that it is my complete responsibility to keep equipment in a safe place within the work area. I
also understand that under no circumstances am I to remove the equipment from the work area
without first completing and signing the Removal of Property Form and submitting it to the
appropriate person.
I am aware that if the equipment is broken, stolen or damaged; it is my responsibility to immediately report
to the appropriate manager or the Director of Purchasing. I also understand that I may be charged for any
damages that occurred while in my possession that are a result of misuse or carelessness. (This is based
on method of damages.)
I understand that once my employment ends, it is my responsibility to return all equipment signed out to
me. Failure to do so will/may result in the witholding of my final paycheck.
By signing below, employee acknowledges that he/she has reviewed this equipment responsibility form,
and accepts the condition set forth as related to the equipment described below.
Responsible Employee
Model #
Serial #
Photo (where applicable)
The responsible party must complete his/her printed name, written signature and date in the spaces
provided below.
Employee Signature
Not signed yet.
Printed version is uncontrolled
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This PDF was created at
Wed, 06 Apr 2022, 10:45 am