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ASSET TRACKING FORM

THIS FORM will be kept in the personnel’s file and be used to track company assets that are assigned to the individual for authorized business use. The HR Department will regularly update this information. The individual must account for and return assets immediately upon request by the department -- or upon separation from employment, prior to final payout -- whichever comes first. INDIVIDUAL RESPONSIBILITY. Individuals are responsible for protecting the Company assets assigned to them and are subject to disciplinary action and financial liability (including deduction from pay or final payout) for the replacement value of assets due to loss of, damage to, or failure to account for and return, the assets. AT SEPARATION FROM EMPLOYMENT. This Asset Tracking Form has a companion document, the Separation Clearance Checklist. Sections of the Checklist must be completed at the time of separation from employment by • The individual • The designated supervisor • The HR Department • The Department Head EMPLOYEE ID ________________ NAME OF EMPLOYEE___________________________ DESIGNATION___________________________

ITEMS/EQUIPMENTS

DESCRIPTION/INFO

RECEIVED BY EMPLOYEE (INITIALS)

LAPTOP LAPTOP BAG USB FLASH DRIVE

DELL E5430 Core I3 EBOX (BROWN) 16 GB (KINGSTON)

AUTHORIZED ISSUED ON BY (DATE) (HOD – INITIALS) 23-11-13 29-11-13 25-11-13

RETURNED ON (DATE)

RECEIVED BY (AUTHORIZED DEP)