Dental Health Services Portal

Company Equipment Allocation Form

I commit to treating company-issued equipment with reasonable care while I am employed, and understand that intentional misuse, damage, or negligent use of such equipment may subject me to disciplinary action, up to and including termination. I hereby acknowledge receipt and assignment of the following company property:

First Name *

Last Name *

Phone Number *

Email *

Employee ID *

Employee Title *

Department *

Supervisor *

Date *

Office Equipment

Office key

Side Gate Key

Entry Gate Remote

Devices

Cell Phone

Cell Phone Charger

Laptop Computer

Laptop Charger

Financial

Credit Card

Other

Draw Signature

Google Captcha

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Company Equipment Allocation Form

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