Spreadsheet: 0abc4142-5c22-4d80-b7d3-9ee65f0bd979
Sheet: Off Campus

University of Idaho Off-Campus Equipment Verification Worksheet
The following piece(s) of equipment are assigned to your custody at a location other than the University of Idaho Campus.  Please fill out all fields on this form.  Use one worksheet per custodian; additional assets may be added to this sheet during the year.  There is room on this form for 2 assets; if this custodian has or adds additional assets, check the "Listing Attached" box below and attach off campus continuation pages (see below).  The Unit Property Administrator (UPA) must verify information and update the form annually.  One form is good for 4 years; then a new form must be generated for all assets off campus for this custodian.  If the information becomes illegible, a new form must be generated.
The "Custodian" shall be the UI Employee responsible for the equipment.  If the item is government-funded, the Principal Investigator (PI) should be listed as the Custodian.  By signing this form, the custodian certifies the equipment is physically verified and the information listed is current, accurate and complete.  If the "Asset User" is also the custodian, write "Custodian" in the asset user field.                    o Listing Attached (___ Pages)                            Please print legibly or save form to your computer and fill out form and print
[NAME]: |  | [NAME]: |  | [NAME]: | [NAME]:
[NAME]: |  | Date: | [NAME]: |  | [NAME]:
Off-Campus Asset User: |  |  | Relationship to Custodian: |  | Is this a private residence? (circle one)
 |  |  |  |  | YES
Off-Campus Location/Address (NO PO BOX) Please include zip code:
 |  |  |  |  | NO
Asset User Acknowledgement: I have read APM section 10.40 [specifically 10.40 C-3 (Off-Campus Use of Property) and APM section 10.40 A-3, ii (Security of Property)] and agree to abide by the policies and procedures contained in APM section 10.40. Please sign in the box to the right. |  |  |  |  | Asset User Signature:
Phone Number: | Status & Condition | Date added: | Unit Name |  | Asset User E-Mail Address:
Year Manufactured: | Description: |  |  | UI Tag Number: | Manufacturer:
Model Number (Use [NAME]'s): |  |  | Serial Number: |  | Asset returned to Campus
 |  |  |  |  | Date:                   Disposed:    Y     N
Off-Campus Asset User: |  |  | Relationship to Custodian: |  | Is this a private residence? (circle one)
 |  |  |  |  | YES
Off-Campus Location/Address (NO PO BOX) Please include zip code:
 |  |  |  |  | NO
Asset User Acknowledgement: I have read APM section 10.40 [specifically 10.40 C-3 (Off-Campus Use of Property) and APM section 10.40 A-3, ii (Security of Property)] and agree to abide by the policies and procedures contained in APM section 10.40. Please sign in the box to the right. |  |  |  |  | Asset User Signature:
Phone Number: | Status & Condition | Date added: | Unit Name |  | Asset User E-Mail Address:
Year Manufactured: | Description: |  |  | UI Tag Number: | Manufacturer:
Model Number (Use [NAME]'s): |  |  | Serial Number: |  | Asset returned to Campus
 |  |  |  |  | Date:                   Disposed:    Y     N
Initial form created: |  | 1st Annual Verification Performed  o |  | 2nd Annual Verification Performed  o | 3rd Annual Verification Performed  o
Date:                   UPA Initials: |  | Date:                   UPA Initials: |  | Date:                   UPA Initials: | Date:                   UPA Initials:
University of Idaho Off-Campus Equipment Verification Worksheet - Continuation Page _____ of _____
Off-Campus Asset User: |  |  | Relationship to Custodian: |  | Is this a private residence? (circle one)
 |  |  |  |  | YES
Off-Campus Location/Address (NO PO BOX) Please include zip code:
 |  |  |  |  | NO
Asset User Acknowledgement: I have read APM section 10.40 [specifically 10.40 C-3 (Off-Campus Use of Property) and APM section 10.40 A-3, ii (Security of Property)] and agree to abide by the policies and procedures contained in APM section 10.40. Please sign in the box to the right. |  |  |  |  | Asset User Signature:
Phone Number: | Status & Condition | Date added: | Unit Name |  | Asset User E-Mail Address:
Year Manufactured: | Description: |  |  | UI Tag Number: | Manufacturer:
Model Number (Use [NAME]'s): |  |  | Serial Number: |  | Asset returned to Campus
 |  |  |  |  | Date:                   Disposed:    Y     N
Off-Campus Asset User: |  |  | Relationship to Custodian: |  | Is this a private residence? (circle one)
 |  |  |  |  | YES
Off-Campus Location/Address (NO PO BOX) Please include zip code:
 |  |  |  |  | NO
Asset User Acknowledgement: I have read APM section 10.40 [specifically 10.40 C-3 (Off-Campus Use of Property) and APM section 10.40 A-3, ii (Security of Property)] and agree to abide by the policies and procedures contained in APM section 10.40. Please sign in the box to the right. |  |  |  |  | Asset User Signature:
Phone Number: | Status & Condition | Date added: | Unit Name |  | Asset User E-Mail Address:
Year Manufactured: | Description: |  |  | UI Tag Number: | Manufacturer:
Model Number (Use [NAME]'s): |  |  | Serial Number: |  | Asset returned to Campus
 |  |  |  |  | Date:                   Disposed:    Y     N
Off-Campus Asset User: |  |  | Relationship to Custodian: |  | Is this a private residence? (circle one)
 |  |  |  |  | YES
Off-Campus Location/Address (NO PO BOX) Please include zip code:
 |  |  |  |  | NO
Asset User Acknowledgement: I have read APM section 10.40 [specifically 10.40 C-3 (Off-Campus Use of Property) and APM section 10.40 A-3, ii (Security of Property)] and agree to abide by the policies and procedures contained in APM section 10.40. Please sign in the box to the right. |  |  |  |  | Asset User Signature:
Phone Number: | Status & Condition | Date added: | Unit Name |  | Asset User E-Mail Address:
Year Manufactured: | Description: |  |  | UI Tag Number: | Manufacturer:
Model Number (Use [NAME]'s): |  |  | Serial Number: |  | Asset returned to Campus
 |  |  |  |  | Date:                   Disposed:    Y     N
University of Idaho Off-Campus Equipment Verification Worksheet Instructions
Purpose:   All equipment that individuals have located off-campus must be documented and accounted for during the physical inventory process.  If you have University of Idaho-owned or government-owned equipment at a non-University of Idaho location, you must complete an Off-Campus Equipment Verification Worksheet.  Use one worksheet per Custodian (there is room for multiple Asset Users who may not be the custodian); additional equipment may be added during the course of the year.
o Listing Attached:  If additional pages are attached for this custodian, check this box.  When copies are given to the Property Management Office (PMO) during your inventory, indicate how many pages are attached.
Annual Update:  Physical verification must be performed annually by the Unit Property Administrator (UPA) for all off-campus assets.  There is room for three Annual Updates on this form.  After four years (initial year plus three updates), please fill out a new form.
Who may fill out this form?  The custodian who has responsibility for the equipment should fill out the form.  The UPA may also fill out the form; regardless of who performs this task, the information should be physically verified against the equipment for accuracy.  If there is a discrepancy, the person who signs the form (Custodian) will be responsible.  The custodian information is listed at the top of the form; if the custodian is not the asset user, that information is listed with each piece of equipment.
Retention:  The UPA must retain a copy of this form at all times.  It may be verified at any time by PMO or Internal Audit or external auditors with PMO permission.
Off-Campus Asset User:  The person using the equipment.  This may be the "Custodian" or it may be the person listed in the "User" field.  If the asset user is also the custodian, then you can simply print "CUSTODIAN" in this field and bypass the "Relationship to Custodian", "Phone Number", and "E-Mail Address" fields.
Relationship to Custodian:  If the asset user is not the custodian, then list the relationship (i.e. [NAME], Temporary Employee, etc.)
Location Field:  This is the location designation as used in the Banner Fixed Asset system.  Please use the same format.
Off-Campus Location/Address:  This is the street address, including city, state and zip code, where the asset resides.  NO PO Boxes please!  Please indicate in the adjacent field whether or not this address is a private residence or not, to ensure privacy of information.
Phone Number:  [NAME] phone number
Status & Condition:  (Status A=Active (In Use), I=Idle (Not In Use); (Condition E=Excellent, G=Good, F=Fair, P=Poor). These should reflect the corresponding fields in the property record in Banner Fixed Assets. Notify the PMO of necessary updates to the codes.
Date Added:  This is the date you added this asset to the form.
Unit Name:  The Unit name. See APM section 10.40 A-1 (Definitions) iv (Unit).
UI Tag Number:   Number on the University of Idaho property tag on the equipment. If there will not be a UI yellow or red tag assigned for this equipment, please use a UI blue tag. Additional blue tags can be obtained from your UPA or the PMO. All off-campus property must have a UI tag affixed to identify ownership.
E-mail Address:  [NAME] address of the Asset User
Year Manufactured:  The year this piece of equipment was manufactured (if known) - should be on the data plate on the equipment.
Description:  What the item is - this is the description in Banner Fixed Assets.
Manufacturer:  Who manufactured the item - this is in the [NAME] field in Banner Fixed Assets.
Model Number:  [NAME]'s model number off the data plate on the equipment - this should be in the Model number field in Banner Fixed Assets.
Serial Number:  Serial number off the data plate on the equipment - this should be in the Serial Number field in Banner Fixed Assets.
Asset returned to Campus:  When the asset is returned to campus, indicate the date of this transaction on the form. If a disposal was involved, indicate Y or [NAME] If returned and subsequently transferred to another individual, a new form is required.
Initial Form Created:  Date the form was initially created for this custodian.
Annual Verification Performed:  The UPA is required to verify once per year that this equipment is still in the location listed on the form.  They check the box when this is complete.
Date/UPA Initials:  The UPA is required to initial the form upon receipt.  Additionally, they will initial annually when the form is updated.