ADAMSON Office of the VPAA

U N I V E R S I T Y

LABORATORY APPARATUS/EQUIPMENT BORROWER’S FORM

(For Faculty Members / Employees)

Name: ____________________________________ Purpose:

Office: ____________________________________ Research
Faculty / Employee ID: _______________________ Laboratory
Date Borrowed: ____________________________ Others (specify): ___________________

SUBJECT
SECTION
SCHEDULE
ROOM
LOCKER #
DATE
GROUP #
EXPT #
EXPT TITLE
PROFESSOR
LIST OF APPARATUS/EQUIPMENT

QTY UNIT DESCRIPTION REMARKS

Note: Attach the necessary documents in borrowing the equipment.

1. Letter of Request with endorsement of immediate supervisor (if applicable)
2. Photocopy of IDFor Engineering Lab, attach the necessary documents in borrowing the equipment.

We have received the above list of apparatus/equipment in good condition and understand the full responsibility of
any damage arising from the experiment.

NO NAME STUD # COURSE SIGNATURE

.
1
2
 3
4
5
6
7
Note: No signature means absent and shall not be accountable to any damage.

ReleasedNoted by: Released by: Returned to:

___________________________ ___________________________ ___________________________

Professor/Lab Coordinator / Lab Laboratory Assistant/Date Lab Coordinator oratory
Head Assistant/ Lab HeadDate

F-COELABVPAA-0054 (034-0116-162)