Step 1: Identifcation - Enter information of the individual receiving key(s) / access credential(s)
Home Campus:
Chancellor's Office Cañada College
College of San Mateo Skyline College
MI Date
Check one:
1
Permanent
2
Adjunct
3
Short-Term*
4
Contracted*
5
External Group*
6
Student Assistant* *
Term End Date:
Step 2: Request Type - Select the type of request
Relocation
Modify Access Damaged Key Damaged Badge Lost Key** Lost Badge** New Key
New Badge
Step 3: Building Access - List Building and Rooms Requiring Access
**Step 4: Replacement / Lost Key(s)/ Badge - Complete this section
Details:
Step 5: Signatures
Signature of Employee Date
Immediate Supervisor (Signature) Printed Name and Title Date Signature of EmployeeDate
Printed Name and Title Date Printed Name
Recipient will be notified via email when key(s) and/or badge is ready for pick up. Effective 02.20.2018
G#
ADDITIONAL INFORMATION: Include access deactivation date/additional information as required.
Facilities Use Only
Key / Badge Serial Number
EMPLOYEE SIGNATURE: My signature below indicates that I have read and understand the attached Key and Lock Procedures. I understand the District's keys SHALL NOT
be loaned, duplicated or transferred. I also understand that in accordance with California Penal Code Section 469, the duplication of keys or attempt to duplicate keys without
authorization is a misdemeanor.
TERMS & CONDITIONS RELEASE AGREEMENT
KEY / ID BADGE REQUEST FORM
NOTE: For buildings with electronic access control, a badge will be required to access certain interior doors. The device will also be programmed to provide access to perimeter
doors before and after regularly scheduled building usage hours.
Last Name First Name
Room No. / Space / Area / Description
Procedure for District Key and Badge Issuance:
1. This Key Request Form must be completed and photo must be taken before any keys or
badge are issued.
2. All key requests must have all
required Approval Signatures.
3. Key(s) will only be issued to the individual whose name is on the key request form. Keys shall
not be loaned to others or duplicated at anytime.
4. Key(s) will be available for pickup at the Office of the Department of Public Safety for the
College that the key(s) are issued for. Valid photo ID must be presented in order to receive
key(s).
Use of Keys and Badge:
District keys shall not be loaned or duplicated. California Penal Code 469 states:
Any person who knowingly makes, duplicates, causes to be duplicated, or uses, or attempts to
make, duplicate, causes to be duplicated, or use, or has in his/her possession any key to a
building or other areas owned, operated or controlled by the State of California, any state
agency, board or commission, a county, city or any public school or community college district
without authorization from the person in charge of such building or area or his designated
representative and with knowledge of the lack of such authorization is guilty of a misdemeanor.
District key(s) are issued for the sole purpose of accessing those building areas which are
necessary in order to perform the individual’s assigned duties/work. Use of such keys shall be
strictly limited to the building areas and timeframes directly associated with performing the
individual’s assigned duties/work.
All keys and locks issued by the District remain the property of the District and can be recalled at
any time.
Return of Keys and Badge:
All District keys and badge must be returned to the Public Safety Office on any campus upon
departure of employee or completion of assigned work by Construction and Service Company
Personnel. Items must be placed in a sealed envelope with the name of the returnee written
clearly on the front.
For Employees Only: The Payroll Office will check with the Public Safety Offices to make sure
that all keys have been returned before the individual's final paycheck is distributed. Departures
of employees include but are not limited to:
1. Termination/Resignation
2. Leaves of absence that are anticipated to exceed 90 days.
Keys and Badges for Construction and Service Company Personnel:
All construction company and service company personnel must have the approval of a Facilities
Manager or the Director of Facilities Maintenance & Operations to obtain a key.
Student Use of Keys and Badge:
Under special circumstances and only when absolutely required, students may be assigned keys
or given access to College facilities with approval of a full-time faculty or manager, the
appropriate Dean, Vice President, and
the Campus Facilities Manager.
Lost or Stolen Keys or Badge:
Lost or stolen keys must be reported immediately to the Public Safety Office or the Campus
Facilities Department.
Costs for replacement of lost or stolen keys and re-keying of locks may be charged to the
employee or the Division in which the employee works.
CONFIRMATION OF RECEIPT
To be signed by applicant upon receiving keys and/or badge
Last Date of Possesion
Division/Department Email Telephone:
(Check all that apply)
Building Key Type
College Vice-President/President
1
(Signature)
1
(Required for Master Access/Master Key approval only)
click to sign
signature
click to edit
![]()
click to sign
signature
click to edit
![]()
click to sign
signature
click to edit
![]()
click to sign
signature
click to edit
![]()
