uchc_logo.gif (10775 bytes)REFERENCE #   B Hit Counter         
                                                                                     INVENTORY CONTROL
                                                                                "TRANSFER OF EQUIPMENT"

MAIL ENTIRE PACKAGE TO:      Inventory Control,  Building J,   MC 6170                                               Phone:   679-1952  
NAME:    
BUILDING: FLOOR: ROOM  #:      TEL. #:      
DEPARTMENT:
MAIL CODE:  MC         E-MAIL: 
1.  
This is notification to transfer ownership of assets from one department to another.
.
 2.  
This is notification that assets have been moved from one location to another.

TRANSFERRED FROM:  Internal Transfers, Complete Line 1.    Off-Campus Transfers, Complete Lines 1 & 2
1.  DEPARTMENT:    
     BUILDING: FLOOR: ROOM  #:     
     CONTACT:      TEL. #: 
2. INSTITUTION:     
     STREET:    ZIP CODE: 
    CITY:      STATE:     

HC NUMBER

DESCRIPTION

HC NUMBER

DESCRIPTION

SPECIAL INSTRUCTIONS: 

CODING:

FISCAL YR

LEDGER

ACCOUNT

SUBCODE

AMOUNT

AUTHORIZED SIGNATURE
 

________________________

IMPORTANT NOTICES TO DEPARTMENT HEAD:

  1. YOUR SIGNATURE ALSO CONFIRMS THAT ALL EQUIPMENT & ACCESSORIES USED WITH/OR HAVING CONTAINED RADIOACTIVE OR OTHER HAZARDOUS MATERIALS, INCLUDING FREON, HAVE BEEN INSPECTED & APPROVED FOR SHIPPING AND/OR STORAGE BY ENVIRONMENTAL & RADIATION SAFETY.
     

  2. YOUR SIGNATURE ALSO CONFIRMS THAT ALL ELECTRONIC STORAGE EQUIPMENT & DEVICES HAVE BEEN PROPERLY CLEANED OF INFORMATION ACCORDING TO UCHC HIPAA POLICIES.

AUTHORIZED SIGNATURES    (Signatures 3-6 are needed only if ownership changes)
RELEASED BY:         ____________________________
5. VICE PRESIDENT FOR RESEARCH
   (Individual Equipment Over $10,000 Only)		 _______
DATE
___________________________
1.  DEPARTMENTAL PROPERTY COORDINATOR		 _______
DATE		 ____________________________
6. DEAN
   (Individual Equipment Over $10,000 Only)		 _______
DATE
___________________________
2. DEPARTMENT HEAD		 _______
DATE		 RECEIVED BY:  
___________________________
3. DIRECTOR OF MATERIALS MANAGEMENT
   (All Asset Transactions)		 _______
DATE		 ___________________________
1.  DEPARTMENTAL PROPERTY COORDINATOR		 _______
DATE
___________________________
4. DIRECTOR OF   PURCHASING
     (Equipment Leases Only)		 _______
DATE		 ____________________________
2.  DEPARTMENT HEAD		 _______
DATE

                                            MAKE A COPY FOR YOUR FILE


IF YOU NEED ASSISTANCE COMPLETING THIS FORM, CALL 679-1952