Please ensure all information provided is accurate before submitting.
Company Name | Department | Location |
---|---|---|
[Your Company Name] | [Your Department | [Your Company Address] |
Please fill out the following information regarding your check-out:
Name | |
Date of Check-Out | |
Reason for Check-Out | |
I. Items to Return
Please indicate below the items you are returning:
Item | Condition |
---|---|
[Description of Item 1] | [Description of Item Condition] |
[Description of Item 2] | [Description of Item Condition] |
[Description of Item 3] | [Description of Item Condition] |
[Description of Item 4] | [Description of Item Condition] |
[Description of Item 5] | [Description of Item Condition] |
[Description of Item 6] | [Description of Item Condition] |
[Description of Item 7] | [Description of Item Condition] |
By checking the box below, you agree to the following terms:
I understand that I am responsible for the safekeeping and return of all checked-out items.
I will report any damages or issues with checked-out items promptly.
I will return all items by the agreed-upon return date and time.
I understand that failure to return items may result in disciplinary action.
If you have any additional comments or feedback, please provide them: |
[Your Name]
[Date]
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