Office of Logistics Management Forms & Catalogs


PAR / Warehouse Forms:


The following forms are used to report annual inventory levels, request adjustments to PAR stocking levels, authorize users for PAR and Warehouse electronic ordering systems, and gain permission to return unused consumable items to the warehouse.


  • LM-3 - e-Portal Authorization - UConn Health
  • LM-3B - Logistics Management Report Request
  • LM-3C - e-Portal Authorization
  • LM-3P - e-Portal Authorization - Pharmacy
  • LM-3S - Surplus PAR Stock Notice
  • LM-5 - Inventory Certificate
  • LM-6 - Inventory Count
  • LM-8 - PAR Request - (Select Format: Excel or PDF)
  • LM-10 - Bill Only
  • LM-14 - New Supply Transfer Voucher (When transferring/borrowing supplies from other departments)
  • IC-9 - Maintenance of Equipment Notice
  • Implantable Device(s), Instruments, or Supplies for Surgical Procedures. See Purchasing Web Page for process Information.

Shipping, Receiving, and Mail Distribution Forms:


These forms are used anytime something needs to leave UConn Health. The LM-17 must be filled out when sending out a FedEx, UPS or USPS package leaving the West Dock, and when a vendor removes equipment from the facility. If you have questions about outbound packages; contact the Help Desk at x1958.


  • LM-16 - Materials Logistics Distribution Form (Sample)
  • LM-17 - Shipping & Return Materials Authorization Form (HCA-614)
  • LM-18 - Mail Service Request Form

Property Administration Forms:


Effective July 1, 2017, all Property Administration forms will be handled using the Electronic Forms Workflow (EFW) system. The instruction manual for the system can be found online as well. Annual training will occur between June and August for first time users and those who wish to keep up to date on any system changes. For continuity, the form options on the new system will retain a similarity to the original form numbers. You will be able to select the following from the dropdown:


  • LM-1 - Move request
  • LM-2 - Disposal / Surplus request
  • IC-3/4 - Transfer or Loan into UConn Health
      • The new IC-3/4 has been formatted to replace the following old forms:
    • IC-1   Equipment Donation Form;
    • IC-1A   Art Donation Form;
    • IC-2   Constructed Equipment Form;
    • IC-3   Temporary Loan, Demonstration or Trial Form;
    • IC-4   Transfer into UConn Health Form
  • IC-5 - Takes the place of both the old IC-5 and IC-5A Property Loan Forms
  • IC-6 - Record of Property Disposition: Transfer, Loss or Other Approved Disposition
  • IC-6A - Trade-In
  • IC-6B - Public Sale
  • IC-6C - Cannibalize

Report of Loss or Damages to Real and Personal Property:


These forms may be required for certain property losses. Contact the Property Administration Manager for more information. All CO-853 forms must have a completed IC-12 signature routing form attached. Signatures must be obtained in the order listed on the IC-12.


  • CO-853 - Report of Adjustment to State-Owned Property
  • IC-12 - Authorization to Submit CO-853

Fleet / Motor Pool Forms:


These forms are used to rent state vehicles for daily or monthly usage. All drivers are subject to abide by the policies and procedures contained within DAS General Letter 115.


  • LM-11 - UConn Health Fleet & Vehicle Request Form
  • LM-11A - Permission for Home Garaging on a Continuous Basis
  • LM-11B - Motor Vehicle Monthly Usage Report

Records Retention Forms:


The Connecticut State Library designates the retention periods and guidelines for all state records. Their website has comprehensive lists to help units determine how long public records should be kept. OLM also has Records Management Liaison Officers (RMLO) to assist units in preparing paperwork to store or dispose of records and to answer any questions related to records retention specific to UConn Health.


  • Iron Mountain Records Transmittal Form
  • Sample: Image of Iron Mountain Box Label
  • RC-050W - Records Retention Schedule Worksheet
  • RC-077 - Request for Removal of Personal Data Files from Agency Records
  • RC-078 - Records Management Liaison Officer Designation Form
  • RC-100 - State Records Center Records Storage List
  • RC-104 - Records Inventory Worksheet
  • RC-108 - State Agency Records Disposition Authorization
  • RC-200 - State Records Center Reference Request
  • State Archives Memorandum of Transfer