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Issued Equipment Notice
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Operation
*
— Select Choice —
Antelope Valley
Atlanta North
Augusta
Carlsbad
Chino
City of Santa Ana
Clean-A-Can
Colorado Springs
Corona
Denver
Dispatch
El Cajon
Florida
Granite Quarry
Greeley
Houston
Lake City
Largo
Milledgeville
Moreno Valley
Norcross
North Carolina
Oceanside
Orange
Phoenix
Rochester
Scottsdale
Seattle
Stoneville
Tucson
West Palm
West Palm Beach
Winston-Salem
Team Member Name
*
First
Last
Date Issued
*
Department
Driver
Yard
Welder
Supervisor
Manager
Admin
Equipment Type
*
— Select Choice —
Mobile Phone
Tablet
Gas Card
PPE
Computer
Other
If Other, please specify Equipment Type
*
Phone Number
*
Card Number
*
Photo of Card
Capture With Your Camera
Camera Preview
PPE Items
*
— Select Choice —
Face Shield
Footwear with Safety Toe
Full-face Respirator
Half-face Respirator
Gloves
Harness
High-visibility Vest
Lanyard
Rain Suit
Safety Glasses/Goggles
Welding Apron
Welding Gloves
Welding Helmet
Welding Jacket
Other
Email Name Date
If Other, please specify PPE Item
*
Computer Brand
*
Store Purchased At
*
Month & Year Purchased
MM
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YYYY
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Serial Number
*
Manager Name
*
First
Last
Manager Email
*
Manager Signature
*
Clear Signature
I acknowledge that while I am working for FleetGenius, LLC, I will take proper care of all company equipment that I am entrusted with and that I will only use said property for company related tasks. I further understand that upon termination, I will return all property of FleetGenius, LLC and that the property will be returned in proper working order. I understand I may be held financially responsible for damaged property. This agreement includes, but is not limited to, mobile devices, accessories for mobile devices, computers, and replacement gas cards. I understand that failure to return equipment will be considered theft and may lead to criminal prosecution by FleetGenius, LLC.
Team Member Signature
*
Clear Signature
Submit