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Equipment Return Acknowledgment Form

A form documenting the return of company property and its condition upon exit, with employee acknowledgment of missing or damaged items and potential deductions.

EQUIPMENT RETURN ACKNOWLEDGMENT Employee: [Name] | ID: [Number] Date: [Date] | Last Working Day: [Date] RETURNED ITEMS Item | Serial/Asset # | Condition | Verified Laptop/Computer | [Serial] | [Good/Fair/Damaged] | ☐ Monitor(s) | [Serial] | [Condition] | ☐ Keyboard/Mouse | [Serial] | [Condition] | ☐ Phone | [Serial] | [Condition] | ☐ ID Badge | — | — | ☐ Access Cards | [ID] | — | ☐ Keys | [ID] | — | ☐ Company Credit Card | [Number] | — | ☐ Documents/Files | — | — | ☐ Other: [Item] | [Serial] | [Condition] | ☐ Other: [Item] | [Serial] | [Condition] | ☐ MISSING OR DAMAGED ITEMS [Item] — Condition: [Damaged/Missing] — Estimated value: [Amount] [Item] — Condition: [Damaged/Missing] — Estimated value: [Amount] Deduction applied: ☐ Yes (Amount: [Amt]) ☐ No ACKNOWLEDGMENT I confirm I have returned all company property in my possession. I understand the value of unreturned or damaged items may be deducted from my final settlement. Employee Signature: _______________________ Date: _______________________ Verified by: [Name] | Signature: _______________________ Date: _______________________

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