Check-Out Form FIEA Survey Equipment

Requestor Information
EWB Team:
Primary Contact:
Email:
Phone number:
Check-Out Agreement
1. The responsible party accepts responsibility for all of the equipment that they are checking out.
2. The responsible party agrees to pay the cost of replacement for all equipment that is lost while under the team's care.
3. The responsible party agrees to pay the cost of replacement for all equipment that is damaged beyond repair which diminishes functionality of the equipment.
4. The responsible party agrees to pay for the cost of repair of any equipment that is damaged to the point that functionality of that equipment is diminished.
5. The responsible party will do everything possible to protect the integrity of the equipment.
6. FIEA and EWB will work together in maintaining the equipment under their care by providing instruction.
7. If EWB is the responsible party, the costs for repair or replacement of any equipment will be included in the final invoice, which FIEA will send to the team after its trip.
8. The EWB team and FIEA project engineer will assess the condition of all equipment before checking it out and after turning it in.
Estimated Total Liability:
(Sum of replacement cost of all checked out equipment)

Date: ______

Check-Out List FIEA Survey Equipment

/ Item
(Model and number) / Donor / Approximate Value / Specs / Check Out Condition / Observations at Check Out / Return Condition / Observations at Return /
Functional / Repairable / Irreparable / Functional / Reparable / Irreparable /
1 / Tripod, Wood heavy duty
(Nedo 200513-185) / $200 / Min height = 1.02 m Max height = 1.69 m Threading = 5/8 in - 11 thread
2 / Tripod, Aluminum
(Seiler Instruments) / $140 / Unknown, Threading = 5/8 in - 11 thread
3 / Transit/Theodolite
(Topcon AG-20P Transit) / University of Idaho / $3,700 / Optical instrument, Stadia Ratio: 100, Magnification: 30X, Horizontal Circle min reading: 20", Vertical Circle min reading: 1',
Carrying case included / Threading does not fit our tripods
4 / Prism Rod
(Seco D10726-02) / $150 / max height = 8.5' / 2.6 m , min height= 5.0' / 1.55 m, Threading = 5/8 in - 11 thread
5 / Prism
(Unknown) / $150 / 30 mm offset, Threading = 5/8 in - 11 thread
Max distance = 2,000 m (GTS-105N) or 1,600 m (GTS-313),
Carrying case included
6 / Triple Prism
(Unknown) / Chris Cauthon / $340 / Tribach for mounting to tripod included,
Max distance = 2,700 m (GTS-105N) or 2,400 m (GTS-313)
Carrying case included
7 / Triple Prism
(Unknown) / Chris Cauthon / $340 / No Tribach
Max distance = 2,700 m (GTS-105N) or 2,400 m (GTS-313),
Carrying case included
8 / Electronic Total Station
(Topcon GTS-105N) / Chris Cauthon / $3,800 / Threading = 5/8 in - 11 thread, Battery life = 9 hours with distance measurement or 40 hours with angle only measurement,
Carrying case included, 2 batteries, 2 battery chargers, rain cover, cleaning cloth, tool kit included
9 / Electronic Total Station
(Topcon GTS-313) / Chris Cauthon / $3,300 / 2 batteries, 1 battery charger, rain cover, tool kit, carrying case included
10 / Data Collector
(Carlson Surveyor+) / Chris Cauthon / $3000 / 8-10 hour battery life, Software: SurveCE version 2.61 6/7/12
11 / Measuring Tape / $20 / Fiberglass, metric only, 30 M / Broken handle
12 / Measuring Tape / $30 / Fiberglass, metric only, 60 M
13 / Retractable Height Rod / $20 / Metric Only, 2 mm demarcations, 2 M height
14 / Folding Measuring Stick / $20 / Metric and Standard, Decimal Feet, 6ft, 180 cm
15 / Plumb Bob / $30
16 / Flagging, ribbons / n/a / 5 partial rolls
17 / Field Books / n/a / 3 (used and unused)
18 / Engineering Pocket Reference / n/a / Pocket reference book
19 / GPS
(Garmin GPSMAP 62) / $300
20 / GPS
(Garmin GPSMAP 62) / $300
21 / GPS
(Garmin eTrex) / $100
22 / GPS
(Garmin eTrex 30) / EIA / $300 / Built in Barometric altimeter
23 / Abney level / $110
24 / Compass/Clinometer
(Suunto Tandem) / University of Arizona / ~$300