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Document No.: 7035
Version #1
Information System Asset Declaration
In your role you may have access to one or more Information System assets (IS assets), including but not limited
to: A desk phone, mobile phone, computer, laptop, or tablet. Please read the form regarding the usage of the
assets that may be assigned to you and sign this form where indicated. When signed, return the original to Human
Thank you.
Employee Details
Name of Employee
I will use any Nurse Maude IS assets allocated to me for work purposes only.
I agree to use only the software that has been authorised for my use.
I will ensure that all log ins and passwords are kept secure and will not be shared with any other person.
I acknowledge that some IS asset usage is monitored and NM may recover any costs associated with any inappropriate use.
I will not use a mobile device while driving.
I will take utmost care and responsibility of any assigned IS assets and report to the IT Helpdesk (03 375-4677) 24 hours a
day, if an IS asset
a) is lost or stolen as soon as it is noticed missing
b) is faulty or broken as soon as possible to enable a replacement
I understand that inappropriate use, or careless handling of any IS asset may result in further investigation by my Manager.
I understand that I am strictly forbidden to download or install material from any source including the Internet onto an IS
asset without prior IT approval.
If granted Internet access, I will not use it to view any offensive content which includes but is not limited to obscene or
harassing language or images; racial, ethnic, sexual or gender specific comments or images; or other comments or images
that would offend someone on the basis of their religious or political beliefs, sexual orientation, national origin or age. Refer
to Information Technology Policy relating to Access and Use of the Internet.
I acknowledge that only removable media (e.g. USB device) owned by Nurse Maude are to be used on NM workstations
(refer to Information Technology Policy relating to Use of Removable Media). I will consult with the IT Department to virus
check any removable media prior to using material on it. If any file on a disk is infected I will not attempt to use it within
Nurse Maude. I will inform IT immediately of the affected workstation and pass the disk over for cleaning/destroying.
The user shall reimburse Nurse Maude for any legal or other expenses incurred by Nurse Maude as a direct or indirect result
of a breach of the above.
On termination I will return any assigned IS assets and all other accessories provided by NM to the front reception at 501
Brougham Street. I understand that failure to do so is likely lead to monies being withheld from my final pay to the value of
the unreturned items. Acknowledging that the swipe card is particularly sensitive as it provides ongoing access to the
residences of the employers’ clients, the employer and employee accept that the swipe card issued to the employee for use
during the employment relationship, must be returned at the time the employment relationship is terminated. It is further
agreed and understood by both parties that wages owing at the time of termination may be withheld until such time as the
swipe card has been returned to the employer.
Employee Signature .......................................................... Date …../……/…..