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Equipment Accountability Form - C

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					                                           Advancing Opportunities
                                        Equipment Accountability Form

It is the intent of Advancing Opportunities to provide employees with the equipment needed to perform daily
tasks to be mobile in the field. The following equipment is the responsibility of the employee listed below until
resignation or termination of employment.


Name_____________________________________________________________________________________

Cell Phone (list phone number) ________________________________________________________________

Laptop Computer
            Model of Computer _____________________________________________________________

                  Service Tag Number ____________________________________________________________

                  Express Service Code ___________________________________________________________

                  Serial Number _________________________________________________________________


Router (Serial Number) ______________________________________________________________________

Hub (Serial Number) ________________________________________________________________________

Fax/Printer/Copier (Serial Number) ____________________________________________________________

Mini Surge Protector (Serial Number) ___________________________________________________________

Other – Please List Item and Serial Number ______________________________________________________

Other – Please List Item and Serial Number ______________________________________________________


The following are employee responsibilities for the above mentioned eqiupment:




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   Employee is responsible for the proper care and use of computer and peripheral equipment assigned to them
    for the use while employed with Advancing Opportunities. All equipment must be used in accordance with
    instructions provided at time of training.

   Employee is responsible to notify supervisor of any stolen, lost or damaged item.

   If equipment is stolen, the employee must notify the proper authority so that a police report may be
    completed and then forward to the Business Office of Advancing Opportunities.

   Supervisors and Information Technology personnel may perform spot inspections of equipment from time
    to time.

   Employees must operate equipment for the use of Advancing Opportunities. operations. This includes no
    unauthorized downloading or installation of software and/or storage of non-agency files on laptop
    computers.

   Cell phones are to be used in accordance with the Agency’s cell phone policy.

   Employees must return all equipment upon resignation or termination of employment with Advancing
    Opportunities. All equipment must be returned in good operating condition with no damage beyond normal
    wear and tear. Final pay compensation will be held by Advancing Opportunities. until equipment is
    returned.

By signing this statement of accountability, I understand and accept my responsibilities as listed above.


_________________________                     _________________________     _________________________
Employee Name (Print)                         Signature                     Date


_________________________                     _________________________     _________________________
Witness Name (Print)                          Signature                     Date



Upon resignation or termination of employment with Advancing Opportunities. all of the above equipment was
returned to said agency and inspected with employee and supervisor present. Equipment was found to be in
good operating condition with no damage beyond normal wear and tear.


_________________________                     _________________________     _________________________
Employee Name (Print)                         Signature                     Date


_________________________                     _________________________     _________________________
Supervisor’s Name (Print)                     Signature                     Date


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