1.	Name:*

2.	Department*

3.	E-mail address*

4.	Phone Number:*

5.	Has Business Services personnel verified capitalized equipment in the last two years?
	Yes No Don't Know

6.	Does the department keep a separate record of equipment valued under the capitalization amount of $5,000?
	Yes No Don't Know If yes, who maintains these records?

7.	Has the department had any equipment stolen in the last two years?
	Yes No Don't Know If yes, explain the circumstances and if/when Public Safety was notified.

	UM Policy 204.1 Thefts ; Public Safety Procedures - Theft

8.	Is any department equipment maintained in other departments, loaned to outside organization or employees, or maintained off campus?
	Yes No Don't Know If yes, explain the monitoring process.

	UM Policy 302.1.1 Property/Equipment - Acquisition ; Business Services Fixed Asset Use Procedure

9.	Is an executed loaned equipment agreement on file?
	Yes No Don't Know

	UM Policy 302.1.1 Property/Equipment - Acquisition ; Business Services Fixed Asset Use Procedure

	For further information: UM Policy 302 Property and Equipment ; UM Policy 204.1 Thefts ; Public Safety Procedures - Theft ; Business Services Capital Asset Procedure ; Business Services Fixed Asset Use Procedure ; Board of Regents Policy and Procedures 401.1 ; Montana Operating Manual (MOM) - Procurement Procedures

	Additional Comments

10.	Any additional comments?