Water Action Volunteers in the field


Sample Equipment Checkout Form


Below is a sample equipment check-out form that you can copy and paste into your word processing program and adapt to meet your local program's needs. Following the date of checkout, you might consider sending a copy of the form to the participant. Thanks to Peggy Compton for sharing the form.



Name: _______________________________ Organization: _______________________

Address: ________________________________________________________________

Phone: _______________________________ E-mail: ____________________________

Check Out Date: ________________________ Return Date: ________________________


How many people were involved in the educational activities associated with the use of this equipment? Include the total number of people in the following categories:

_________ youth
_________ adults


_______ female
_______ male

_____ White
_____ Black
_____ Asian
_____ Hispanic
_____ American Indian


Return Policy:
Equipment should be returned promptly, clean and ready for the next use. The hip-boots must be returned with dry interiors. No fees will be charged for the normal use of materials or equipment. However, a fee will be imposed for materials returned in an unacceptable manner (i.e. wet hip-boots, spilled chemicals, groundwater model not drained and cleaned).


The Water Education Resource Center emphasizes the idea of safety first, at all times in the field and in the laboratory. YOU must make safety your primary concern through the use of proper procedures and precautionary measures. It is best to demonstrate chemical test kits in a controlled setting, such as a classroom before using the tests in the field. Emphasize correct lab procedures and safety concerns during the demonstration. Wear safety goggles or other certified protective eye wear when doing chemical tests. Vinyl or latex gloves should be made available for any chemical test. If you would like copies of material safety data sheets (MSDS), contact the Water Education Resource Center. Have a safe and enjoyable learning experience.


I have read the above information and checked out the following equipment: _______________________________


Items borrowed:__[list items here]__

© 2007 by the Board of Regents of the University of Wisconsin System, UW-Extension provides equal opportunities in employment and programming, including Title IX requirements. UW-Extension programs are open to all persons without regard to race, color, ethnic background, or economic circumstances. All rights reserved.
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