IT Equipment Environmental Disposal Compliance Form
Employee Name
Department
Equipment Type
Asset Tag/Serial No.
Equipment Condition
Working
Not Working
Damaged
Has all data been securely erased?
Yes
No
N/A
Disposal Method
Recycling
Reuse/Donation
Certified E-Waste Disposal
Disposal Vendor / Service Provider
Disposal Date
Additional Notes
Employee Signature
Date Signed