This disposal form requires a work order number from Facilities and allows departments to assign their own disposal numbers. It must be filled out for any items in poor or scrap condition being disposed, with information on the requestor, department, location, quantities, and descriptions of items. Signatures are needed from both the department inventory coordinator and head to authorize the disposal and certify the items are free of hazardous materials.

1. DISPOSAL FORM
WORK ORDER #
UB Facilities will email the Work Order # to the Requestor.
This number must appear on the form attached to the item.
DISPOSAL #
Departments may assign their own disposal number.
IT IS ILLEGAL TO REMOVE EQUIPMENT/FURNITURE
WITHOUT PROPER FORMS ON FILE.
THIS FORM IS FOR ITEMS IN “POOR” OR “SCRAP” CONDITION.
Date _
Requestor
Print/type name
Department
Email _ Phone _
Inventory Account # _
Location for pick up _
(Different locations require separate forms)
Qty Asset # Serial # Mfr. Model Description
The signatures below ascertain that the condition of the above listed items are in “poor” or “scrap” condition
and authorizes their disposal. Also, the signatures below certify that the equipment listed is free from any and
all radioactive or hazardous materials.
Signature of Dept. Inventory Coordinator
Print/type Inventory Coordinator name ________________
Email address
Signature of Department Head
Print/type Department Head name
This form must contain two separate authorized signatures as indicated.
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Asset Management