Equipment Sign Out Sheet Template

• Employee Name

• Department

• Prepared by

• Date & Time

  Date
• Location
  Address

Equipment Sign Out

• Click "Add"

Item

• Item/ Equipment Issued

• Quantity

• Equipment Condition

  Select Good working order - No damage Regular visual inspection- Slightly impaired Other

  • Good working order - No damage
  • Regular visual inspection- Slightly impaired
  • Other

Issuance

• Date Issued

  Date

• Do you need to specify a return date?

  Yes

  No

• Return Date

  Date

• I agree to comply with the ESS safe work policies of using this equipment in accordance with the training and instruction provided and will return the equipment on time.

• Employee Number (if available)

• Employee's Full Name & Signature

  Sign

Completion

• Additional Notes

• Full Name & Signature of Approver

  Sign