Key Release Form

• Document No.

• Audit Title

• Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

By signing below, I agree to accept liability for the equipment, Chemical and key listed below. I understand that should any damages occur that exceed the warranty of the merchandise while the equipment is in my possession, I will be held fully responsible and liable for the full amount of the repairs/replacement of the equipment. And also if I lost the key, I will be held fully responsible and liable for the full amount of the replacement of the keys which I have. And also I am take full responsibility use of chemical listed below and I read (SDS) Safety Data sheet.

• Site Name

• Cleaner Full Name

• Passport/Driving License/Photo ID

• Passport/Driving License/Photo ID

  Media

• Serial Number of the Key

• Number of Keys

• By Signing here, I am confirming that I will take care the site key and I will take all the responsibility until returning to the Dutra Management.

  Sign