Equipment Return Receipt Form

Location

This letter is to document that the following equipment were received:*

Other: Please Specify

Name of Person Returning Equipment*

First Last

Date Returned*

Signature

Passcode*

EAS Designee Receiving the Equipment:

Name of Person Receiving Equipment*

First Last

Position

Date Received*

Date Released to Company

Are items in good condition?*

Please discuss in detail:

Signature of Employee Receiving Equipment*

Please sign here once endorsement is complete.