Republic of the PhilippinesNEGROS ORIENTAL STATE UNIVERSITY

Main Campus I & II, Dumaguete CityNegros Oriental, Philippines 6200

COLLEGE OF NURSING, DENTISTRY, PHARMACY AND ALLIED HEALTH SCIENCES

NURSING DEPARTMENTBORROWER’S SLIP

Date : _____________________________

Subject : _____________________________

EQUIPMENT Borrowed Quantity Unit

1. __________________________________________ _________ ________2. __________________________________________ _________ ________3. __________________________________________ _________ ________4. __________________________________________ _________ ________5. __________________________________________ _________ ________6. __________________________________________ _________ ________7. __________________________________________ _________ ________8. __________________________________________ _________ ________9. __________________________________________ _________ ________10. __________________________________________ _________ ________11. __________________________________________ _________ ________12. __________________________________________ _________ ________

By:

________________________________Student’s Name & Signature

Noted By:

____________________________Instructor’s Name & Signature _____________________________

Date/Time ReleasedReceived By:

Camad C. Ali, Jr. _____________________________Laboratory Assistant Date/Time Returned

Republic of the PhilippinesNEGROS ORIENTAL STATE UNIVERSITY

Main Campus I & II, Dumaguete CityNegros Oriental, Philippines 6200

COLLEGE OF NURSING, DENTISTRY, PHARMACY AND ALLIED HEALTH SCIENCES

NURSING DEPARTMENTBORROWER’S SLIP

Date : _____________________________

Subject : _____________________________

EQUIPMENT Borrowed Quantity Unit

13. __________________________________________ _________ ________14. __________________________________________ _________ ________15. __________________________________________ _________ ________16. __________________________________________ _________ ________17. __________________________________________ _________ ________18. __________________________________________ _________ ________19. __________________________________________ _________ ________20. __________________________________________ _________ ________21. __________________________________________ _________ ________22. __________________________________________ _________ ________23. __________________________________________ _________ ________24. __________________________________________ _________ ________

By:

________________________________Student’s Name & Signature

Noted By:

____________________________Instructor’s Name & Signature _____________________________

Date/Time ReleasedReceived By:

Camad C. Ali, Jr. _____________________________Laboratory Assistant Date/Time Returned