BROADCAST EQUIPMENT BORROWER`S FORM

BROADCAST EQUIPMENT BORROWER`S FORM
BROADCAST EQUIPMENT BORROWER’S FORM
Dept./College : ________________________________
Purpose
: ________________________________
Venue
: ________________________________
Date Filed
Date Needed
Time of Use
: __________________
: __________________
: ________ to ________
EQUIPMENT CHECKLIST
Set # or
Label
Color:
ITEMS
Qty.
Logged
Out
Qty. Returned and Remarks
(To be signed by the
SA in-charge with date)
Panasonic AGDVC 20P
3CCD 500X Digital Zoom 10X Optical Zoom
(Black Camera Recorder)
1. White Lens Cap
2. Black Shoulder Strap
3. Panasonic Remote Control
4. Panasonic Lithium Battery Charger
5. AC mains lead (for battery charger)
6. DC Input lead (for battery charger)
7. Lithium Battery 1 of 2
8. Lithium Battery 2 of 2
9. Ferrite Core (for DV cable)
10. DV Head Cleaner
Sub-total no. of Items:
Sony Digital HDV 1080i
Model No. GV-HD700-1 (Black)
1. Black Sony Remote Control (RMT-844)
2. Sony AC Power Adaptor (AC-L100 C)
3. Power Adaptor’s Cable
4. A/V Connection Cable – Yellow, Red & White
5. Video Component Cable – Green, Red & Blue
6. USB Cable - Gray
Sub-total no. of Items:
Video Switcher SE-500 with Adapter and RGB Cable
Tripod Benro KH25
Sub-total no. of Items:
Others (if any):
TOTAL NO. OF ITEMS:
Equipment checked and issued by: ________________________
Student Assistant in-charge
AGREEMENT:
I acknowledge the receipt of the above equipment and take full responsibility for its maintenance and order; to
return all equipment in good condition after the activity; pay for any damage/loss caused by negligence,
mishandling or vandalism.
Name of Borrower: _____________________________________
Signature over printed name of Faculty In-Charge
Approved by: ___________________
CITS Head
Client’s copy
BROADCAST EQUIPMENT BORROWER’S FORM
Dept./College : ________________________________
Purpose
: ________________________________
Venue
: ________________________________
Date Filed
Date Needed
Time of Use
: __________________
: __________________
: ________ to ________
EQUIPMENT CHECKLIST
Set # or
Label
Color:
ITEMS
Qty.
Logged
Out
Qty. Returned and Remarks
(To be signed by the
SA in-charge with date)
Panasonic AGDVC 20P
3CCD 500X Digital Zoom 10X Optical Zoom
(Black Camera Recorder)
11. White Lens Cap
12. Black Shoulder Strap
13. Panasonic Remote Control
14. Panasonic Lithium Battery Charger
15. AC mains lead (for battery charger)
16. DC Input lead (for battery charger)
17. Lithium Battery 1 of 2
18. Lithium Battery 2 of 2
19. Ferrite Core (for DV cable)
20. DV Head Cleaner
Sub-total no. of Items:
Sony Digital HDV 1080i
Model No. GV-HD700-1 (Black)
7. Black Sony Remote Control (RMT-844)
8. Sony AC Power Adaptor (AC-L100 C)
9. Power Adaptor’s Cable
10. A/V Connection Cable – Yellow, Red & White
11. Video Component Cable – Green, Red & Blue
12. USB Cable - Gray
Sub-total no. of Items:
Video Switcher SE-500 with Adapter and RGB Cable
Tripod Benro KH25
Sub-total no. of Items:
Others (if any):
TOTAL NO. OF ITEMS:
Equipment checked and issued by: ________________________
Student Assistant in-charge
AGREEMENT:
I acknowledge the receipt of the above equipment and take full responsibility for its maintenance and order; to
return all equipment in good condition after the activity; pay for any damage/loss caused by negligence,
mishandling or vandalism.
Name of Borrower: _____________________________________
Signature over printed name of Faculty In-Charge
Approved by: ___________________
CITS Head
CITS’ copy
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