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SIUE Remote Work Equipment Loan Form

All SIUE employees requesting to checkout work equipment are required to complete the Remote Work Equipment Loan form.

1. Provide all requested information (required areas are indicated by a red asterisk - *). Check with your director or supervisor if you are uncertain about how to complete a certain area.

2. When you are finished, electronically sign the form and click the "Next" button to submit the request form to your supervisor for review.

*Employee Information

Name:

SIUE ID number (ex: 800XXXXXX):

SIUE email address (ex: ecougar@siue.edu)

Employee Department:

Office/Room Number

Phone Number

*Employee Supervisor Information

Employee Dean/Director Name:

Employee Dean/Director Email Address:

Employee Chair/Supervisor Name:

Employee Chair/Supervisor Email Address:

Equipment Details

Include the equipment and/or supplies that are required to work remotely, indicating items that will be provided by the department.

**Equipment Details**

Include the equipment and/or supplies that are required to work remotely, indicating items that will be provided by the department.
	ITEM Name/Type	SIUE Tag or Serial Number	Original Campus Location	Service Tag (if applicable)
Item 1	Item 1	Item 2	Item 4	Item 5
Item 2	Item 1	Item 2	Item 4	Item 5
Item 3	Item 1	Item 2	Item 4	Item 5
Item 4	Item 1	Item 2	Item 4	Item 5
Item 5	Item 1	Item 2	Item 4	Item 5
Item 6	Item 1	Item 2	Item 4	Item 5
Item 7	Item 1	Item 2	Item 4	Item 5
Item 8	Item 1	Item 2	Item 4	Item 5
Item 9	Item 1	Item 2	Item 4	Item 5
Item 10	Item 1	Item 2	Item 4	Item 5

*Remote Work Location

Provide the address of the remote work location the equipment will be housed.

*Additional Equipment

Do you need to add additional equipment or supplies to work remotely?

Yes
No

Additional Equipment Details

Include the equipment and/or supplies that are required to work remotely, indicating items that will be provided by the department and items that you will provide.

**Additional Equipment Details**

Include the equipment and/or supplies that are required to work remotely, indicating items that will be provided by the department and items that you will provide.
	ITEM Name/Type	SIUE Tag or Serial Number	Original Campus Location	Service Tag (if applicable)
Item 1	Item 1	Item 2	Item 4	Item 5
Item 2	Item 1	Item 2	Item 4	Item 5
Item 3	Item 1	Item 2	Item 4	Item 5
Item 4	Item 1	Item 2	Item 4	Item 5
Item 5	Item 1	Item 2	Item 4	Item 5
Item 6	Item 1	Item 2	Item 4	Item 5
Item 7	Item 1	Item 2	Item 4	Item 5
Item 8	Item 1	Item 2	Item 4	Item 5
Item 9	Item 1	Item 2	Item 4	Item 5
Item 10	Item 1	Item 2	Item 4	Item 5

Instructions for Employee Signature

You are required to electronically sign this request form. You can sign the form using your mouse or, if you're completing the request using a mobile device (smart phone, tablet, etc.), you can sign using your finger or a stylus.

By signing below you confirm that:

I agree to return all equipment upon request. I will return all items signed out to me in good working order and understand that I am responsible for any repairs or replacement of equipment due to negligence.

*Employee Signature

Sign Here

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