KEY REQUEST /CARD ACCESSFORM FACILITY OPERATIONS

RESET

Account number to be charged: ___

Department Head Requesting: ___

Issue to: ___

Last Name First Name MI

Position:___ Phone No___

Reason for Request:

TO KEY CONTROL

TO CARD CONTROL

Building Name: ___

___

Room Number(s):___ ___

<div style="text-align: center;"><img src="imgs/img_in_image_box_11_24_788_78.jpg" alt="Image" width="95%" /></div>

Name & Signature Required

Department Head/Director___ Name___ Date___

Card access only

Card access only

Director, Auxiliary Services ___ Date ___

___

Building Master/Grand Master

President ___ Date ___

1/2

FOR DEPARTMENTAL USE ONLY

Issued to:_____ Key number issued:_____ Date issue:_____

1st Issue: ___ *Lost Key: ___ Duplicate Issue: ___

Missing Key Policy:

* In the event that key/s should be unaccounted for or lost, the department that requested the said key/s will be held responsible for all charges associated with re-corning and issuing new keys. A police report will be required before new keys are issued