Clinical Simulation Equipment Loan Request

Please complete this form if you are interested in borrowing simulation equipment.

We need at least 24 hours to prepare your equipment loan. You will receive an email asking for clarification or confirming your loan from simulation@uabmc.edu within 24 business hours. If you need your loan before noon of the next business day, we may not be able to fulfill your request.

If you have questions about simulation events or scheduling, please email simulation@uabmc.edu directly.

Name(Required)

First Last

Email(Required)

Phone(Required)

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Location(Required)

BlazerID(Required)

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ARHC Hospital

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Please specify

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Requested Item (Please use the + sign to add more items. You can add up to three items.)(Required)

Requested Item

Quantity Needed

What equipment do you need to borrow for your event? If you run out of space or need more than 3 items, please put additional equipment in the Comment box. Please note that whole body manikins need to remain in the simulation lab.

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Event Name/Class(Required)

What equipment do you need to borrow?(Required)

Please describe how you are going to use it.(Required)

Pick Up Date(Required)

Return Date(Required)

Comments

Consent(Required)

Borrower is responsible for the safe use of the equipment and for any damages.

Borrower will communicate any changes in pick-up or return dates of equipment to simulation@uabmc.edu promptly.

Borrower will return any supplies that accompany the loan so that they may be repurposed.

Borrower will complete a brief survey to provide information about the use of the loaned equipment at the time of the return.

I agree