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Camin Cargo Computer Equipment Report

Report Of ( Lost | Damaged | Stolen ) Equipment (Circle One)


Date Reported:

_________________________

Event Date:

_________________________

Equipment Assigned to:

_________________________

Equipment Make and Model:

_________________________

Branch Office:

_________________________

Polaris ID:

_________________________

Original Purchase Date:

_________________________

Original Cost (IT):

_________________________

Replacement Cost (IT)

_________________________

IT Notes and Reports:


_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Manager Explanation and Comments:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Notes: stolen must attach police report, damaged include images and describe situation.
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Company policy states:
All equipment losses and damages will be tracked and Carlos in conjunction with the
corresponding manager will decide whether the user will be financially responsible.
Stolen equipment will be consider personal event/fault unless proven inside a terminal/job
location and will have to be reimbursed by user, the company will not place insurance claims for
equipment stolen outside job locations.
For repeat offenders, repairs and software reconfiguration due to virus infections or nonapproved software installations will be deducted from payroll as stated in our ISR policy.
Manager Approval: ____________________________

Date: _________________
Rev.3 05/26/2011

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