Exhibit G_Equipment Inventory Form.docx

This is an Equipment Inventory Form used for the Grounds Maintenance contract at Lufkin State Supported Living Center (LFSSLC) in Texas. The form must be completed jointly by the Contractor's on-site supervisor and an ASH (likely Arlington State Hospital or similar state agency) Representative each time the contractor enters and exits a patient-accessible area. The form tracks equipment movement through numbered line items, recording quantities in and out, and whether items are accounted for. Each entry and exit requires verification by an ASH Representative with documented times, and the form includes space to record the specific courtyard or area accessed, the contractor company name, and any discrepancies noted during the inventory process.

This document serves as a control mechanism to ensure accountability and security of equipment within patient-accessible areas of the facility. The form's structure supports compliance with patient safety and facility security protocols by requiring dual verification of all equipment movements and maintaining a clear audit trail. The requirement for joint completion between contractor and facility personnel establishes clear documentation of equipment accountability and helps prevent loss or unauthorized removal of items from patient areas.