Equipment Loan Agreement Form - ntgpe

Equipment Loan Agreement FormNorthern Territory General Practice Education Ltd. (NTGPE) makes available the following equipment forProgram Participants to enhance their placement experience.I ______________________________________________________________ (print name) practicing/placed at_____________________________________ agree to the conditions listed for the loan of the equipmentindicated below (please tick appropriate box/s).Camera (specify make)IPad (specify number)_______________________________________________________________________________Mobile Phone (specify make and number)______________________________________The period of loan will be from ……../…..…/…..… to …..…/..……/….…..1. The equipment provided will be returned to NTGPE located at Yellow Precinct, Building 1, Level 3,CDU Casuarina Campus at the completion of the loan period.2. Loss of any equipment must be reported to the NTGPE office at the time of the incident. In addition,loss of the camera, IPad and/or mobile phone requires a full Police Report delivered to the NTGPEoffice within 14 days of the incident.3. Equipment will be stored in a secured location when not in use.4. Equipment will be stored in cases provided and in a manner that avoids unnecessary damage (eg.sun or water damage). Any damage relating to negligence may incur a cost to the borrower.5. The borrower will not undertake any actions that may void the warranty of equipment (eg. repairs ormodifications) and will adhere to any specific terms and conditions.6. Abuse of any terms and conditions or damage to equipment will be billed to the borrower, includingthe cost of repair, excess charges or other costs incurred that are not covered under warranty.7. Equipment is to be used exclusively for its intended purpose during placement and training, be inworking order on return and used exclusively by the borrower during the loan period.8. Any photographs taken by the camera will be the property of NTGPE and will potentially be used forthe promotion of NTGPE programs via media, conference attendance and general promotion. Acopy will be provided on CD for your personal use at the end of your placement of any photos taken.9. Due to the sensitivity of taking photos in Aboriginal communities and in particular of Indigenouspeople, an Authorisation to Publish and Reproduce Form is attached for the talent to sign to allowNTGPE to use their photo. Copies of photos can only be used for personal purposes. Use in othercircumstances will require NTGPE expressed permission. This is to protect people and communitiesrepresented in the photos.This is a quality controlled document which may not be current once printed and must not be altered without the approval of the Authority.Page 1 of 2

10. The borrower of the IPad shall; not install any software on the computer without the consent of NTGPE; not restore the IPad to factory defaults or restore it in ITunes11. Mobile phones are provided where ‘Next G’ service is available. It is the borrower’s responsibility totop up phones when required at local post shops, service stations etc. There is no additional chargefor the use of these phones.I have read the terms of the Equipment Loan Agreement Form and agree to abide by them for the duration of theloan. I understand that should I fail to undertake the above mentioned conditions that I will be liable forassociated costs.Borrower_____________________________________________(Signature)______________________(Contact number)Date: ____/____/____NTGPE Representative_____________________________________________(Print Name)________________________________________(Signature)Date: ____/____/____Return of EquipmentDate: ____/____/____Returned by___________________________________________ ____________________________________________(Print Name)(Signature)NTGPE Representative___________________________________________(Print Name)____________________________________________(Signature)This is a quality controlled document which may not be current once printed and must not be altered without the approval of the Authority.Page 2 of 2