Waterfront Elementary School

Asset Tracking Form

(PLEASE PRINT)

Employee Number: ____________ (found on the top of your pay stub)

Type: Laptop / Handheld / Other (circle one)

Model: ___________________________________

Serial Number: ____________________________

In consideration of the Buffalo Public School District permitting my use of the above-described equipment at school/work or off district grounds, and intending to be legally bound, I agree to the following:

I acknowledge receipt of the above-mentioned hardware.

I agree to take the necessary precautions to ensure the continued working condition and security of the above-mentioned hardware. In the event of damage / malfunction, I will report this to the District Technology Help Desk (851-3510).

If the above-mentioned hardware is lost, stolen or vandalized:

I will notify my school principal / department head, I will file a police report, I will copy the police report to my principal / department head, District Security Office (William “Bill” Jackson) and the Information Technology Department (Beth Kassirer 816-4055).

I agree to return the above-mentioned hardware, complete and in working order:

Upon request of the Department of Information Technology, upon termination of employment with the District, upon transfer within the District in a job area not assigned a computer.

I agree to abide by all software copyright laws and / or the Buffalo Public School District Acceptable Use Policy. I understand that I may not load any software onto my computer not legally licensed by the Buffalo Public School District without the specific permission of the Department of Information Technology.

Name (please print): ___________________________

Signature: ___________________________________ Date: _____________

(For Office Use Only)

Expected Return Date (if applicable): ________________

Return Date: ___________________________________ Return Condition: _____________

Received by (IT staff): ____________________________

Buffalo Public School District / Buffalo New York Adapted for Waterfront June 2005

*Originally/Last issued to _________________________@ School #95- Returned in ____________ Condition