Employee Equipment Liability Form:

Employee Information:
Name: __________________________________________
Employee ID: ____________________________________
Department: ______________________________________

Company-Provided Equipment:
Description of Equipment: ___________________________
Serial/Asset Number: _______________________________
Date of Issuance: __________________________________
Condition at Issuance: ______________________________

Company-Provided Equipment:
Description of Equipment: ___________________________
Serial/Asset Number: _______________________________
Date of Issuance: __________________________________
Condition at Issuance: ______________________________

Company-Provided Equipment:
Description of Equipment: ___________________________
Serial/Asset Number: _______________________________
Date of Issuance: __________________________________
Condition at Issuance: ______________________________

Company-Provided Equipment:
Description of Equipment: ___________________________
Serial/Asset Number: _______________________________
Date of Issuance: __________________________________
Condition at Issuance: ______________________________

Company-Provided Equipment:
Description of Equipment: ___________________________
Serial/Asset Number: _______________________________
Date of Issuance: __________________________________
Condition at Issuance: ______________________________

Company-Provided Equipment:
Description of Equipment: ___________________________
Serial/Asset Number: _______________________________
Date of Issuance: __________________________________
Condition at Issuance: ______________________________

Responsibilities:
1. I understand that the company has provided me with the above-listed equipment for work-
related purposes.
2. I will use the equipment responsibly and solely for authorized job duties.
3. I will take reasonable care to protect the equipment from damage, loss, theft, or
unauthorized use.
4. I will report any damage, loss, or malfunction of the equipment to my manager
immediately.
5. I will not lend, sell, or transfer the equipment to any other individual or entity without
explicit permission from the company.
6. I will not modify, alter, or attempt to repair the equipment without proper authorization.
7. I will return the equipment to the company upon the termination of my employment or
when requested by my manager.

Liability and Damages:

1. I understand that I am fully responsible for the equipment provided to me and will be held
liable for any damage, loss, theft, or negligence.
2. I will bear the costs associated with repairing or replacing the equipment due to my
misconduct, negligence, or violation of the terms outlined in this form.
3. I authorize the company to deduct any costs related to the repair or replacement of the
equipment from my wages or any other amounts owed to me.

Return of Equipment:
1. Upon termination of my employment or when requested by my manager, I will return the
equipment in the same condition as it was issued, excluding normal wear and tear.
2. I understand that failure to return the equipment in a timely manner or in acceptable
condition may result in legal action and the withholding of my final wages or benefits.

Acknowledgment:
I have read, understood, and agree to comply with the terms and responsibilities outlined in
this Employee Equipment Liability Form. I acknowledge that I am responsible for the
company-provided equipment and will adhere to the guidelines stated herein.

Employee Signature: _______________________________

Date: __________________________

Manager Signature: ______________________

Date: __________________________