BIOMECHANICS EQUIPMENT/SUPPORT/SETUP/LOAN REQUISITION FORM

INFORMATION (Complete ALL sections and provide additional detail if necessary)

This form must be emailed by 4:00pm 7 days before the equipment/setup or support is required.

Name / Click here to enter name / Module Name and level / Click here to enter module /
Mobile/Contact No. / Click here to enter contact number / Email / Click here to enter email
Activity Type / Select an activity / Location of Activity / Select a location
If other, please specify
Date/Time equipment required/collected / Select a start date
Select a start time / Date/Time of completion/return / Select an end date
Select an end time
Equipment needed / Equipment needed
Digital Camcorder / ☐ / Kistler Force Plate (Lab) / ☐
Digital Camcorder x 2 / ☐ / Kistler Force Plate (SPA) / ☐
Digital Camcorder x 3 / ☐ / Noraxon EMG / ☐
Digital Camcorder x 4 / ☐ / EMG electrodes / ☐
High-speed Digital Camera / ☐ / Kistler Accelerometer / ☐
2D Qualisys (pro-reflex) / ☐ / Treadmill / ☐
3D Qualisys (pro-reflex) / ☐ / Lab PC’s – Dartfish Pro-suite / ☐
Reflective Markers / ☐ / Lab PC’s - QTM / ☐
Non-reflective Markers / ☐ / Lab PC’s – C-motion / ☐
Lamps / ☐ / Lab PC’s - Bioware / ☐
Extension cables / ☐ / Plyo boxes / ☐
Oqus camera / ☐ / Cybex / ☐
Please provide any additional details not listed above. (eg. questionnaire or test title)
Click here to enter text. /
Do you require setup, training or support using the equipment?
Click here to enter text. /
Do you require the same equipment/setup/support on another date/time?
Date / Start Time / End Time / Location
Select a start date / Select a start time / Select an end time / Select a location
Select a start date / Select a start time / Select an end time / Select a location
Select a start date / Select a start time / Select an end time / Select a location
Select a start date / Select a start time / Select an end time / Select a location

…………………………………………………………………………………………………………

To be completed by a technician

Return of equipment
Date / Time / Condition / Staff member
Select a date / Select a time / Choose a condition / Staff member /