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Assets
Reggie
2022-06-06T10:22:13-05:00
Asset Inventory Form
Step
1
of
2
50%
Hidden
Date
(Required)
MM slash DD slash YYYY
Device Type
(Required)
Device Type
Radio
Lifepak 15
IV Pump
Vent
Other
Radio Type
(Required)
Radio Type
Truck Mounted/Mobile
Handheld/Portal
Other Type Description
(Required)
Serial Number
(Required)
If no Serial Number enter "N/A"
Make/Manufacturer
(Required)
I.E. Kenwood, Motorola, Physio-Control, ETC.
Model Number
(Required)
If No Model Number enter "N/A"
Deployed to?
(Required)
Deployed to
Unit/Crew (Device Stays with Crew)
Truck (Device Stays with Truck)
Station (Device Stays at Station until needed)
Unit Deployed
(Required)
Full Unit Number
Truck Deployed
(Required)
Truck/Vehicle Number
Station Deployed
(Required)
Device Condition
(Required)
Select Condition
Perfect - No Defects - Looks and Works Like Brand New
Great - Some Obvious Wear - Works like Brand New
Good - Doesn't look great but everything works
Poor - Doesn't Look good and needs minor repair
Inoperable - Must be taken out of service
Describe Condition
(Required)
Photos
Device Photo
(Required)
Max. file size: 16 MB.
Photo of Entire Device
Information Panel
(Required)
Max. file size: 16 MB.
Device Information Panel (I.E. Serial Number, Model Number, Date of Manufacture, etc)
Damage/Problem Photo
(Required)
Drop files here or
Select files
Max. file size: 16 MB.
Upload photos of damage and wear and tear. (Can Upload Multiple photos)
Attestation
(Required)
I attest that the information above is true and accurate and I personally am the one that gathered this information and entered it into this form.
Attested By:
(Required)
First
Last
Attestation Signature
(Required)
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