Equipment Loss Report
California State University Fresno

TO PROPERTY CONTROL

This is to report the loss of equipment belonging to _____________________________ (Department or Office title)

Date loss or theft occured ____/____/____ Time ________ Building ______________ Rm ______
If equipment was stored in a room or cabinet, were locks secured?________ Cabled down? ________
If no, explain ___________________________________________________________________________

Was equipment found missing during inventory?__________ What precautions are in effect to prevent any further loss of equipment? __________________________________________________________________

Have you notified the University Police?______
If no, explain ___________________________________________________________________

If equipment was lost or stolen off campus, were local authorities informed? ________
If no, explain ___________________________________________________________________

Attach copy of Equipment Agreement Check-out, if applicable.

DESCRIPTION OF PROPERTY ITEM

Item ____________________________________________________________________________

CSUF Tag No. __________________________ Serial No. ________________________

Brand Name _________________________________ Model No. ______________________________

SUMMARIZE OTHER DETAILS RELATING TO THIS LOSS

______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________

Is there insurance to cover this loss? ________
If yes, please indicate insurance company_________________________________
Has the insurance company been contacted? ________

__________________________________________
 __________________________________________
property control designee, Date
 Dean, Director or Department Head, Date

______________________________________________________________________________________
Lost, stolen or destroyed equipment will be charged against responsible individuals if negligence was involved.