INVENTORY CONTROL
INVENTORY
CONTROL
RECORD OF PROPERTY LOANED, LEASED OR CONSIGNED TO HEALTH CENTER- IC 3
DATE: _____/_____/_____ DEPARTMENT:
_______________________________________
LENDER, LEASER, OR CONSIGNOR NAME:
___________________________________________
ADDRESS: _______________________________________________
_______________________________________________ PHONE: ( ____ ) -
_____-____
DESCRIPTION OR ITEM:
____________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
( Include Identifying Serial Number, Size, Color etc.)
COST: ________________________ (OR) APPRAISED VALUE:
_____________________________
DATE OF AGREEMENT: (If Any) _____/_____/_____
SPECIAL TERMS OF AGREEMENT: (If Any)
__________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
DATE RECEIVED: _____/_____/_____ DATE TO BE RETURNED:
_____/_____/_____
LOCATION IN HEALTH CENTER:
____________________________________________________
PURPOSE OR INTENDED USE:
_______________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
SIGNATURES:
__________________________________________ _____/_____/_____
Department Head Date
__________________________________________ _____/_____/_____
Dean Date
__________________________________________ _____/_____/_____
Inventory Control
Date
INCLUDE A COPY OF RELEVANT DOCUMENT.