Facilities Management Key Request
DateRequested:__________________________________DateReceived:__________________
RequestersTitle___________________________________ ASUID:________________________
Name:___________________________________________ Contact#_______________________
RequestersDepartment:________________________________________________________________
FOAP:____________________________________________________________ ___________________
Key Information
Building:__________________________ Room/Door#:_____________________
Key#(Ifknown):__________________________ _____________________________________________
NewKeyCutorReassign:_______________________________________________________________
OldKeyHolderName(IfKnown):_________________________________________________________
I,theundersigned,byacceptingtheidentifiedkey,herebyagreetotakediligentcareandpromptlyreportandloss
thereof.Ifurtheragreenottogivepossessionofsaidkeytoanyotherperson,norcauseorallowanycopiestobe
madeofsaidkey.Iunderstandthatanyviolation
ofthisagreementmayresultindisciplinaryactionbythe
Administrationofthisinstitution.
Estimatedreplacementvalueofthiskeyis$25perlockthatkeyoperates.
EmployeeSignature:_________________________________________ __________________________
Dept.Chair/Supervisor:________________________ ________________________________________
Dean/Director:________________________________________________________________________
FacilitiesUseOnly
CoreMark:____________________ KeyLevel:________________________
Key#:________________________ WorkOrder#:____________________
KeyWay:B/RC________________
FM:___________________________________________________Date:_____________________
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