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Employee #:
PLEASE REFER TO PAGE 2 OF THIS FORM FOR THE LIST OF ISSUED EQUIPMENT
NAME (Last, First): __________________________________________________________________________________________
WORK PHONE #: ____________________________________
WORK E-MAIL #: ____________________________________ PERSONAL E-MAIL #: ______________________________
CELL PHONE #: ____________________________________
DEPARTMENT: ______________________________________ JOB TITLE: _________________________________________
EQUIPMENT ASSIGNMENT AGREEMENT
___________________________________________________ _______________________________
Date (MM/DD/YYYY)Employee Signature
___________________________________________________ _______________________________
Date (MM/DD/YYYY)Manager/Supervisor Signature
___________________________________________________ _______________________________
Date (MM/DD/YYYY)IT Representative Signature
You have been assigned ASA College-owned equipment (listed on the next page) to complete your job duties and, accordingly, you are temporarily assuming responsi-
bility for the item(s).
The College is deeply concerned with safety in the workplace. If you are unsure of the proper and safe way of using any piece of assigned equipment, you must contact
your manager immediately. You should never use any piece of equipment in a way that you know or suspect may be unsafe. Likewise, you should immediately report
any problems or damage to, or resulting from, a College-owned piece of equipment as well as the theft of the equipment.
You should take reasonable precautions to protect the equipment and comply with any applicable College policy regarding its use. You also should not use College-
owned equipment for non-work related tasks, or allow non-employees to use the equipment. When the task has been completed for which the equipment was
assigned, or at the time of your resignation or termination, you must promptly return all assigned College-owned equipment to your manager.
It is Manager’s responsibility to request return of equipment from an employee at the time of termination or resignation.
Manager must immediately notify IT department of the employee resignation or termination, so the returned College-owned equipment can be properly inspected and
the College Owned Equipment Return form can be lled and signed.
If Equipment wasn't returned or returned with damages or missing parts, HR department must be notied, so the payroll deductions could be made from the
employee’s pay. The College also reserves the right to pursue other legal and criminal methods, if warranted.
I, _________________________________________________________________________________________
(Last Name, First Name)
acknowledge the foregoing terms of using College-owned equipment listed on page 2 of this agreement and agree
to abide by its terms.
EMPLOYEE INFORMATION:
A copy of this form must be kept on le within the department and HR.
It is recommended that employee keeps the copy of the form for his/her record as well.
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