e. Transfer of Custodians. When a custodian is relieved and a successor
custodian designated, transfer or accountability must be accomplished.
Joint inventory. The retiring custodian will close and balance all records,
prepare a bank reconciliation to show both the bank and journal balances as well as the
outstanding checks, and count the cash on hand. The successor custodian will verify this
The joint statements (see figure 5-1) are prepared in quadruplicate and
all copies signed by the appropriate custodian. Records, keys, cash valuables, etc. are
turned over to the succeeding custodian who signs all copies of the appropriate statement
after verifying that no discrepancy exists.
Statement of Outgoing Custodian
Statement of New Custodian
I have, this ___ day of ______ 19__, transferred to
I have, this _____day of ______ 19___, received from
__________ , the new custodian, $____________ cash
_________ , the sum of $____________ presenting the balance
Patients Trust Fund in _________________________
due patients, together with valuables listed on the individual
(Name of Bank)
patients' deposit records, and I hereby relieve him from all
__________and all items listed on Patients' deposit records.
responsibility for the Patients' Trust Fund.
(Grade and SSN)
(Grade and SSN)
Figure 5-1. Statements of outgoing and new custodians.
New combination/lock for security container. When a safe is provided for
the use of the custodian, the combination is changed upon transfer of funds and valuables
to a successor custodian.
New authorization signature cards. When the actual transfer of the PTF is
accomplished, the original of the above statements and a signature card bearing the
signature of the new custodian are forwarded to the hospital commander. The hospital
commander gives written notice of the change to the local bank and encloses the signature
card of the new custodian. The three remaining copies of the custodians' statements are
distributed to the outgoing custodian, the new custodian, and the files of the PTF.