ࡱ> ~` bjbj 0D <H$$$$,$ ChX%\%\%\%\%'''BBBBBBB$(EhGeC1)?'@'1)1)CC"\%\%zC)))1)R\%\%B)1)B))<">\%L% @,Ģ˨$A)y=A?C0C=6HQ)|H,>H>|'>',)'$ ($'''CC#C )'''C1)1)1)1) $ d "6D Deans, Chairs, and Directors are responsible for the care, custody and control of all equipment within their respective areas, including equipment, which leaves campus. This form is to be completed for all equipment that is being taken off campus prior to it leaving. Please see Insurance & Risk Managements website for policy and procedures relating to insurance coverage and claims for off campus equipment. When the length of usage off campus is greater than 1 month or the equipment is going outside of Canada it is the responsibility of the department to update the equipment record(s) on the Equipment Inventory Management System (For more information on Off Campus Equipment Usage Guidelines go to www.inventory.ualberta.ca) Individual requesting permission to take equipment off campus:Department:Campus Address:Telephone: Description of EquipmentU of A Tag # Serial # Est. $ Value  Please note if there is any existing damage to the equipment:Portable Equipment: Annual use is being granted Date leaving campus:Date returning to campus:Where will equipment be located off campus? Signature of individual taking equipment off campus and acknowledging responsibility for the equipment: Permission to take equipment off campus is granted by (must be a Dean, Chair, Director, or other senior administration):Printed NameDateSignatureDateSignatureALBERTA Freedom of Information and Protection of Privacy Act (FOIPP): By signing above, I consent to having the information in this document collected by The Governors of the ϲ. The personal information requested on this form is collected under the authority of the Universities Act and Section 33 (c) of the FOIPP Act to determine authorization to remove equipment from a University facility for the above named department. Certain personal information may be made available to federal and provincial government departments and agencies under appropriate legislative authority. Personal information is protected under the ϲ FOIPP Act. For use after equipment is returnedDate equipment is returned: Receipt of returned equipment is acknowledged by:Print NamePositionSignature____ Check here if damaged and attach details Distribution: Original: to be retained by Department / A paper copy no longer needs to be sent to Equipment Inventory Services  INSURANCE & RISK MANAGEMENT Off Campus Equipment Form    & a x  ? I  ࿳||pg[OgAhcah{6>*CJaJhcahj6CJaJhcahzf6CJaJhca6CJaJhcahca6CJaJhcaCJaJhcahcaCJaJhcahzfCJ\aJhhCJ\aJhhTYCJ\aJhhpXCJ\aJhhpX5CJ\aJh}CJaJhhzfCJaJhhpXCJaJ(jhh_CJUaJmHnHu ! " . 0 1 JTkd}$$IfT0+b634aTTkd$$IfT0+z 634aT$Ifgdzf   ! 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