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  • Any item (i.e. phones, keys, bank card or other) removed from its secure storage area (safe, key box etc.) needs to be signed out using this form.

    Removal of any item without authorisation and/or completion of this documentation may constitute an act of theft and such action will make the person acting in that manner liable for any costs associated with replacement, legal prosecution, recovery of costs & possible termination of employment.

    Any costs associate with the loss or damage caused to an item that is removed from storage is the responsibility of the person removing of that damage is caused through an act of negligence, ill intent, malice, carelessness, recklessness or other other similar unreasonable action. Personal liability noted in the previous sentence for damage excludes any reasonable damage caused by normal wear and tear, fatigue over time or ordinary software crashes/issues.

    By proceeding to remove an item from storage, the person below understands, acknowledges and accepts their personal financial liability as described above and agrees to return the item at the end of each business day to its safe storage area (safe, lockbox etc.) and that person also agrees to NOT LEAVE THE PHONE/EQUIPMENT UNATTENDED AT ANY TIME FOR ANY REASON WHATSOVER unless it has been returned and signed back in to the register, and that person also agrees to NOT LEND THE PHONE/EQUIPMENT TO ANYONE understanding and accepting that failure to comply with this condition will result in any associated costs for repair/replacement being recovered from the person who signed the phone/equipment out. Please sign here to acknowledge that you understand, acknowledge and accept these terms and conditions:

  • FIRST Name of person signing:

  • LAST Name of person signing:

  • Date of signing:

  • Signature:

Item Register

  • Item Sign In / Out Date:

  • Item Description:

  • “Other Item” selected, please describe:

  • Item Front Photo

  • Item Back Photo

  • Are you removing or returning the item?

  • Is the item damaged?

  • Was the item damaged during your current use of it?

  • How did the damage occur?

  • Is the item functioning correctly?

  • Did the item stop function correctly during your use of it?

  • Describe what happened:

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.