TRANSFERRING DEPT. ONLY:
Date: Phone:
Pho
Page 1 of _____
Central Connecticut State University
New Britain, CT 06050
EQUIPMENT INVENTORY
CHANGE REQUEST
All applicable sections of this form must be filled out and
forwarded to Property & Inventory Control. If questions, contact
Property & Inventory Control at Ext. 22321 or 22308.
Name of Department TRANSFERRING Equipment:
______________________________________________________
Contact Person:
PRINT Name__________________________________________
If TRANSPORT is required, be sure to also submit a separate
work order request in the ERPortal work order system for
moving. Please enter work order number below.
IMPORTANT INSTRUCTIONS: Work Order #:
1) This is NOT an Off-Campus Loan Form. If you are taking equipment off-campus, you must fill out an Off-Campus Loan Form.
2) If transport of item(s) is required, be sure to also submit a separate work order request in the ERPortal work order system for moving.
3) This form is for internal transfers only; i.e., transferring equipment from one location to another location on the CCSU campus only.
4) Sections A, B, C and D must be filled out below. Section C must indicate reason for equipment transfer.
5) Signatures are required by both the department transferring the equipment and the department receiving the equipment.
6) Keep a copy of this signed form in your file. It is your proof of the relocation of your equipment.
A. Equipment Identification
Inventory Bar Code
Number
From Location: Building and
Room Number
(MANDATORY)
To Location: Building and
Room Number
(MANDATORY)
14.
If additional space is required,
use “Continuation Form”
B. Dept. Name RECEIVING Equipment
Responsible Recipient’s Name
PRINT Name_____________________________________________
Signature (Required):
C. REASON FOR EQUIPMENT TRANSFER (REQUIRED): (For example: Non-Serviceable, No Longer Needed, etc.)
D. Department Head Approval (Transferring Equipment):
Signature
Print Name: (Required): Date:
Rev. 7/20/11
