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Dublin City School District
Employee Equipment Sign-out / Sign-in Form
• Each request must be documented below.
• Return sign-out/sign-in form to Treasurer’s Office when full OR at each school break.
• The undersigned (individual borrowing equipment) accepts full responsibility for the equipment itemized below. Further, they agree to abide by Board Policy 7530 and
the following conditions:
1. All appropriate personnel have been informed that the equipment is being borrowed.
2. No consumable materials have been taken from the district.
3. The equipment will be returned in the same condition in which it was borrowed, or if not, the undersigned will accept full responsibility for the costs to repair or
replace the equipment.
4. The equipment will not be used for personal gain such as receipt of money, goods, or services, for services rendered.
Building/Department Name: _____________________________________________________________________________________________
Name
of Employee
Asset
Description
DCSD
Tag #
Date
Borrowed
Condition
(good,
fair, poor)
Empl.
initials
Principal
/Dept.
head
initials
Date
Returned
Condition
(good,
fair, poor)
Empl.
Initials
Principal
/Dept.
head
initials
White: Treasurer Yellow: Building
Property
7530B F1
Revised 7/22/09