EMPLOYEE LOCKER ACCOUNTABILITY FORM EMPLOYEE LOCKER ACCOUNTABILITY FORM

Document: Employee Locker Accountability Form Document: Employee Locker Accountability Form

Document Version: 7 Document Version: 7

This is to acknowledge that I Mr./Ms._________________________________________________________ This is to acknowledge that I Mr./Ms._________________________________________________________

with Employee Number _______________________ whose signature appears below has received one (1) with Employee Number _______________________ whose signature appears below has received one (1)
unit of locker with the following details unit of locker with the following details

ACCOUNT: ______________________________ ACCOUNT: ______________________________

IMMEDIATE SUPERVISOR: ______________________________ IMMEDIATE SUPERVISOR: ______________________________

LOCKER NUMBER: ______________________________ LOCKER NUMBER: ______________________________

By affixing my signature, I hereby acknowledge that I have been issued with the above locker in good working
condition and that I am fullyaware of the Locker Policies & Guidelines that I need to strictly abide with. As an
employee, I am responsible & accountable for any damage/misuse of my assigned locker unit and any
violation of the policies & guidelines would be dealt with accordingly based on the Alorica Employee Code of
Conduct for Improper Use of Company Owned Properties and other applicable Policies.
By affixing my signature, I hereby acknowledge that I have been issued with the above locker in good working
condition and that I am fullyaware of the Locker Policies & Guidelines that I need to strictly abide with. As an
employee, I am responsible & accountable for any damage/misuse of my assigned locker unit and any
violation of the policies & guidelines would be dealt with accordingly based on the Alorica Employee Code of
Conduct for Improper Use of Company Owned Properties and other applicable Policies.

I undertake to comply with the following Padlock Requirements: I undertake to comply with the following Padlock Requirements:

1. To Use a Heavy Duty Type of Padlock (Must be 4-5mm Thick in Diameter) 1. To Use a Heavy Duty Type of Padlock (Must be 4-5mm Thick in Diameter)
2. Not to Use a Combination Type of Padlock 2. Not to Use a Combination Type of Padlock
3. Not to share my assigned locker to anyone 3. Not to share my assigned locker to anyone

I am fully aware that lockers are part of company properties and understand that the assigned locker is only a I am fully aware that lockers are part of company properties and understand that the assigned locker is only a
privilege extended to me. I acknowledge that it is my responsibility to ensure the safety & security of all my privilege extended to me. I acknowledge that it is my responsibility to ensure the safety & security of all my
personal belongings stored inside the locker and any item lost will be on my own accountability. personal belongings stored inside the locker and any item lost will be on my own accountability.

It is hereby agreed and understood that failure to vacate and surrender the assigned locker unit upon my It is hereby agreed and understood that failure to vacate and surrender the assigned locker unit upon my
discontinuance from employment will give the company the right to forcibly open the locker after 5 business discontinuance from employment will give the company the right to forcibly open the locker after 5 business
days from date of separation. days from date of separation.

I voluntary release the company from any liabilities and waive my rights from any claim arising from the forced I voluntary release the company from any liabilities and waive my rights from any claim arising from the forced
opening of the locker unit assigned to me during my employment and upon due notice. Hence, the item/s I opening of the locker unit assigned to me during my employment and upon due notice. Hence, the item/s I
would not claim within 30 days or 1 month upon date locker is forcibly opened, would then be disposed by Admin would not claim within 30 days or 1 month upon date locker is forcibly opened, would then be disposed by Admin
Department thru donation to different NGOs, government hospitals or foundations or similar establishments. Department thru donation to different NGOs, government hospitals or foundations or similar establishments.

This accountability form is signed and executed this ______________________ (M/D/Y). This accountability form is signed and executed this ______________________ (M/D/Y).

Employee Name: _________________________ Employee Name: _________________________

Employee Signature: _________________________ Employee Signature: _________________________

Noted & Received By: _________________________ Noted & Received By: _________________________

FACILITIES’ COPY EMPLOYEE’S COPY