School District Property Check Out Form
Instructions
The form on the following page is used when
checking out any type of equipment. All of the
information needs to be filled out and the form
signed by the principal and the person checking
the equipment out. By signing this form, the
employee needs to understand they are
assuming all responsibility for the items in case
of damage or theft.
Once all pertinent information is filled out, the
White Copy should be sent in care of the Fixed
Assets Specialist located in the Business Office.
School District Property - Check Out Form
BORROWER’S INFORMATION
Name:
Home Address:
City:
State:
Zip Code:
Renter’s or Home Insurance Company:
Policy #:
EQUIPMENT BEING CHECKED OUT
District Bar Code Number:
Description:
Serial Number:
Model Number:
Date Checked Out:
Date Returned to School:
Initialed after returned:
GUIDELINES PER SCHOOL DISTRICT REGULATION #2830-1
Any district employee intending use of school property off school district premises will use the following
guidelines:
1.
2.
3.
4.
5.
Obtain authorization from the appropriate building or district-level administrator.
Provide proof of homeowners or rental liability insurance.
Be responsible for placing the equipment in the area to be used.
Be responsible for any charges incurred during the use of such school district equipment (such
as unauthorized or personal telephone calls on cellular phones).
Be responsible for repairing damaged equipment or replacing lost, stolen or destroyed
equipment.
I understand, agree to, and meet the requirements and conditions as listed above.
Signature:
Date:
Authorized by:
Date:
DISTRIBUTION: Original Copy - Fixed Assets Specialist, Business Office
Copy -- Principal
Copy – Employee
Revised 10/05