Lost/Stolen Equipment Report Form Instructions Purpose The Lost

Lost/Stolen Equipment Report
Form Instructions
The Lost/Stolen Equipment Report Form was developed to enhance GRU's asset management
process, and as necessary, to provide details should an internal investigation be warranted when
regulated or sensitive data was stored on a lost or stolen “smart” device.
The following instructions are provided to assure critical information concerning lost or stolen
equipment is reported in a timely manner, as well as to keep GRU senior management informed.
Process Instructions
1. Complete the online form, print, sign and submit as directed.
2. The Lost/Stolen Equipment Report Form must be completed by the Department’s
Assistant Property Control Officer for each incident in which a PC; a laptop; a
Blackberry; a scanner; a copier; a printer; etc. is identified as being possibly lost or
For example, if a laptop is missing or stolen, then one report must be submitted
to properly identify the property and to provide information as to its use. Two
missing laptops would require two separate reports, etc.
3. Each item of lost or stolen property must be reported as soon as it becomes apparent that
the Department is no longer able to account for its whereabouts.
4. Each completed report must be signed and dated by the Department Head.
5. The Department Head (or designee) must assure a signed report copy is promptly
forwarded to the Department’s appropriate Cabinet member.
6. Identify this Cabinet member and the forwarding date in the space provided at the bottom
of the form.
7. The original signed report is to be promptly forwarded to Assets Management (Annex I,
HSB 336) and is intended to coincide with a lost/stolen property report to Public Safety.
Form Instructions
Contact Information
• Dept. Name-- Identify the reporting department
• Date--Report date
• Dept Head-- The name of the Department Head signing the report.
• Phone #-- The GRU office phone number of the Department Head.
• Asst. Property Control Officer-- The name of the Assistant Property Control Officer
completing the report.
• Phone#--The GRU office phone number of the Assistant Property Control Officer
Identifying Lost/Stolen Property
• Tag Number -- The GRU property tag number (Bar Code) which is physically attached
to the equipment
• Principled Assigned Location--Where the property is used or kept?
o Example: HS 3135 or for home use, 123 Easy Street, Augusta, GA 30912
• Serial Number-- As listed on the Inventory Listing
• Description/ Manufacturer/ Model--– as listed on the Inventory Listing
o Example: Laptop/Dell/PP18L
• Is the device’s power cord lost/stolen, too?-- Respond “Yes” or “No” or “Unknown”
• Operating System-- MAC or Windows
o Example: Windows XP Professional
• Notify local law enforcement if lost or stolen from an off campus location
• Specific Location where lost/stolen-- Provide as much information related to the last
known location - office, home, hotel, airport, street, city, state, zip, country
o Examples:
ƒ GRU Annex Building, HS 3135, Walton Way & 15th Street, Augusta
Georgia, 30912
ƒ Westin City Center, 1400 M Street NW, Washington, DC, 20005
ƒ IKEA AB. Visiting Address: Ikeag. 7. SE-343 81 ÄLMHULT Sweden
ƒ Hartsfield-Jackson Atlanta International Airport 6000 North Terminal
Parkway, Atlanta, Georgia 30320, Gate: B21, Airtran
• Approximate Date Last Used/Last Seen-- Month, Day, Year
• Date When Loss Discovered--Month, Day, Year may vary from date last used/seen
• Actions Leading to Discovery of Loss/Theft-- Provide a detailed explanation as to how
missing/lost status was determined, what was done to locate the equipment and the reason
for the loss, if known.
Due Diligence Reporting
Note: The Assistant Property Control Manager must collaborate with the equipment’s “owner” to
provide the following details:
Person Assigned Property-- Provide Name and GRU Building Name /Room# and Phone
o Example: John Doe, MD, Pavilion I, AF 123, 1-1224
Was the device password protected? Respond “Yes” or “No”
Check any type(s) of data saved to the device’s “C” drive, “My Documents” or memory?
o Check any combination of data stored to the device. Be sure to list any other data
type not already listed on the report form. If there is no data saved to the device,
then be sure to check “none.”
Action Taken to Address the Loss/Theft of the Equipment with Responsible Individual
The Department Head is responsible for completing this narrative. If no action was taken, then
should be noted here. If the loss is due to negligence, the responsible employee can be held
financially liable.
Questions about the reporting process or form?
Contact the Office of Asset Management at 706 721- 1796.
LOST/STOLEN EQUIPMENT REPORT To Be Completed by the Assistant Property Control Officer Dept. Name: Date:
Dept. Head: Phone#
Asst. Property Control Officer: Phone#
Identify Lost/Stolen Property by completing the following information: Tag Number
Principal Assigned Location Serial #
Description/Manufacturer/ Model Is the device’s power cord lost / stolen? Yes No Unknown Where was Property Lost/Stolen? ( Provide Specifics: Office Addressor Home or Other Location, Street, City, Zip, Country) Operating System
Local Police Notified? Yes Police Report # No Date When Loss Noticed:
Approximate Date Last Used/Last Seen Details of Loss (Explain actions leading to discovery; steps taken to locate; reason for loss) Due Diligence Reporting: 1.
Person assigned property: Name:
Bldg./Rm. #/Phone #: 2.
Was the device password protected?
c:/document/inventory/Lost‐Stolen Property Report 3.
Check any type(s) of data saved to the device’s “C” drive, “My Documents,” or memory: (next page)
__Bank Account Information __Mother’s Maiden Name
__Checking/Saving Account Information __Dates of Birth
__Medical Insurance Information __Telephone Numbers
__Health Information __Names of Spouses and Children
__Protected Health Information __Mailing /Street Address/Zip
__ Medical Data __Medical Record Numbers
__Passport/Immigration Information __SSN
__Payroll/Compensation __Fax/Telephone Numbers
__Financial Data __Tax Identification Numbers
__Research Data __Credit/Debit Card Numbers
__Donor/Funding Sources __Personal Identification Numbers (PINs)
__Email Address __Insurance ID Numbers
__Passwords __Driver’s License Numbers
__Intellectual Property __License/Tag Numbers
__Digital Images/Videos/Audio of Humans __Bank Account Numbers
__Biometric Identifiers __Certificate/License Numbers
__Vehicle Identifiers __Device Identifiers and Serial Numbers
__IP Addresses __Employee/Student ID Numbers
__Student Educational Records
__ None
List Other Identifiable Data or Institutional Data Saved: 4.
Action taken by the Department Head to address the loss/ theft of the equipment with responsible individual:
Dept. Head Printed Name: Dept. Head Signature CC: __________________________________ Date of Notification to Cabinet Member: _______________________ (Cabinet Member’s Name) This form is finalized when the following are completed: •
Signed by the Department Head •
Original to the Office of Asset Management • Copy to Cabinet Member
c:/document/inventory/Lost‐Stolen Property Report