Hi Bill
The version of the delivery note we used to use looked like the example below and didn't have a section for the rep to complete after the end of the loan period. The rep would just complete the details and sign the delivery note at the start of the loan at either From A or Form B section. We did the same as you though regarding logging the device, creating a job number, labelling, return, etc. And it was contained on just one side of A4 thus saving the odd rainforest!
Rob
NHS Delivery Note
Date ______________________ day of _________________________ 200_____
Supplier ____________________________________________________________
PASA Supplier Indemnity Reference Number (IFA)___________________________
Authority ("Premises") _________________________________________________
This NHS Delivery Note is supplementary to the NHS Form of Indemnity with the reference number shown above.
Model/make _________________________________________________
Serial Number _______________________________________________
Value ______________________________________________________
Description __________________________________________________
Purpose _____________________________________________________
Form of Indemnity A
The Supplier wishes to make the Equipment detailed above available to the Authority for the following period of time:-
Period [ ] years and [ ] months commencing on [ ] day of [ ] 200
The trial/testing to be undertaken by the Authority (if any) _____________
___________________________________________________________
The Authority acknowledges receipt of the Equipment detailed above on the terms of the Form of Indemnity detailed above and this NHS Delivery Note:-
SIGNED on behalf of the Authority _______________________________
The Supplier hereby loans the Equipment detailed above to the Authority on the terms of the Form of Indemnity detailed above and this NHS Delivery Note:-
SIGNED on behalf of the Supplier ________________________________
Form of Indemnity B
The Authority hereby receives the Goods detailed above from the Supplier on the terms of the Form of Indemnity detailed above and this NHS Delivery Note:-
SIGNED on behalf of the Authority ________________________________
The Supplier hereby transfers the legal and equitable title to the Goods detailed above to the Authority as from the date hereof on the terms of the Form of Indemnity detailed above and this NHS Delivery Note:-
SIGNED on behalf of the Supplier ________________________________