Exhibit G_Equipment Inventory Form.docx

This is an Equipment Inventory Form exhibit for a patient area entry and exit control document used by a contractor and the ASH (likely a healthcare facility or organization) Representative. The form establishes a joint verification process requiring the Contractor's on-site supervisor and ASH Representative to complete the inventory at every entry into and exit from patient-accessible areas. The form provides ten numbered line items for documenting equipment descriptions, quantities entering and exiting the patient area, and accountability verification. Required documentation includes the date, courtyard or area designation, contractor company name, entry verification by ASH Representative with time stamp, exit verification by ASH Representative with time stamp, and space for noting any discrepancies discovered during the inventory process.

This exhibit serves as a control mechanism to ensure equipment accountability and security within healthcare facilities, preventing unauthorized removal or loss of materials from patient-accessible areas. The form's requirement for dual signature verification by both contractor and ASH representatives creates an audit trail and ensures transparency in equipment management. The document does not specify pricing terms, contract duration, or funding requirements, as it functions solely as an operational control tool within the larger contract scope.