GFT Equipment Delivery/Return Form

• Prepared by

• Document No.

• Is this an Equipment Issue or Return (Separate Reports Required For Each Activity)

  ISSUE

  RETURN

• Issued / Returned on

  Date
• Location issued
  Address

ISSUING EQUIPMENT

Are you Issuing Equipment?

• YES

  NO

• Choose Equipment

  Select Disc Cutter Trench Rammer Whacker Plate Towable Roller Hydraulic Core Drill Mini Digger Roller Trailer Machine Trailer Wheel Barrow Other

  • Disc Cutter
  • Trench Rammer
  • Whacker Plate
  • Towable Roller
  • Hydraulic Core Drill
  • Mini Digger
  • Roller Trailer
  • Machine Trailer
  • Wheel Barrow
  • Other

• If Selected "Other", Provide Description

• Equipment Serial Number / Identification Number

• Provide Time Stamped Photos Of all Equipment Issued (including Equipment Serial Number / Identification Number)

  Media

• Is the equipment in proper working order and good condition?

  Select Yes No Working Properly - Fair & Acceptable Condition Working Properly - Poor & Unacceptable Condition

  • Yes
  • No
  • Working Properly - Fair & Acceptable Condition
  • Working Properly - Poor & Unacceptable Condition

• Do NOT issue this equipment for use. Return item to depot. Provide Photos

  Media

• Do NOT issue this equipment for use. Return item to depot. Provide Photos

  Media

• Do Not issue this equipment for use. Return item to depot. Provide Photos.

  Media

Signatures - By signing , I acknowledge that I received the equipment that is listed above. I understand that this equipment is my responsibility to take care of. If it is damaged, lost, stolen or I don't return it when requested; I will be responsible for the repair / replacement costs. I acknowledge and authorise the value be deducted from any outstanding payment I'm owed.

• Name & Signature of Person Receiving Equipment :

  Sign

• Name & Signature of Person Delivering Equipment

  Sign

RETURNINIG EQUIPMENT

• Are you Returning Equipment?

  YES

  NO

• Choose Equipment

  Select Disc Cutter Trench Rammer Whacker Plate Towable Roller Hydraulic Core Drill Mini Digger Roller Trailer Machine Trailer Wheel Barrow Other

  • Disc Cutter
  • Trench Rammer
  • Whacker Plate
  • Towable Roller
  • Hydraulic Core Drill
  • Mini Digger
  • Roller Trailer
  • Machine Trailer
  • Wheel Barrow
  • Other

• If Selected "Other", Provide Description

• Equipment Serial Number / Identification Number

• Provide Time Stamped Photos Of all Equipment Returning (including Equipment Serial Number / Identification Number)

  Media

• Is the equipment in proper working order and good condition?

  Select Yes No Working Properly - Fair & Acceptable Condition Working Properly - Poor & Unacceptable Condition

  • Yes
  • No
  • Working Properly - Fair & Acceptable Condition
  • Working Properly - Poor & Unacceptable Condition

• Remove from circulation and arrange replacement or repair.

• Remove from circulation and arrange replacement or repair.

Signatures - By signing , I acknowledge that I am returning the equipment that is listed above. I understand that if it is damaged I will be responsible for the repair / replacement costs. I acknowledge and authorise the value be deducted from any outstanding payment I'm owed. On completion of this form, responsibility is transferred to the person receiving the equipment.

• Name & Signature of Person Returning the Equipment

  Sign

• Name & Signature of Person Receiving Equipment

  Sign
• Location Received
  Address