Revised 1/2/2013
7387 S. Campus View Drive • West Jordan, UT 84084
PHONE: 801-567-8150 • FAX: 801-567-8056
www.jordandistrict.org
June LeMaster, Ph.D., Administrator
TEMPORARY EQUIPMENT USE AGREEMENT
E
MPLOYEE
I
NFORMATION
Name: Social Security No. XXX-XX-
Address:
Telephone:
School/Place of Work: Assignment
Year-round School Yes No Track Assignment (if year-round)
Temporary Location(s) of Equipment:
Effective Date: Anticipated Return Date:
A
GREEMENT
1. The equipment is, and shall at all times, remain the property of the Jordan School District.
2. Equipment shall not be loaned or transferred to a third party.
3. Equipment shall not be modified in any way without written consent from the Human Resources
Department.
4. The employee shall immediately report any equipment malfunction or maintenance requests to the
Human Resources Department.
5. Jordan School District will not be held responsible for any personal injury or property damage incurred
to or occasioned by the user through the use of this equipment.
6. The equipment is to remain at the assigned location at all times. Equipment may not be removed from
District property without prior written consent from the Human Resources Department.
7. If use of the equipment exceeds the end of the current school year, a request must be made in writing
for the next school year.
S
IGNATURES
Employee: Date:
Principal: Date:
E
QUIPMENT TO BE
U
SED
As an accommodation, the Human Resources Department agrees to make the following equipment temporarily
available for the employee’s use for the time period outlined in this agreement.
Asset Number Equipment Description
Human Resources Approval: Date:
