Key Liability Form
Key Code
Number of
Keys Issued
Date Received
Employee
Initials
Date Returned
I, the undersigned, acknowledge receipt of the keys designated above. I also agree
not to loan, transfer, give possession for misuse, modify or alter the above keys. I
further agree not to cause, allow or contribute to the making of any unauthorized
copies of the above keys. I also understand that it is my responsibility to return all
keys issued to me to my departmental Key Coordinator.
I understand and agree that violation of this agreement or loss of the keys
designated above due to my negligence, may result in disciplinary action and may
render me responsible for the expenses of a rekey for the affected areas.
Printed Name: _____________________________________
Signature: _____________________________________
Date: _____________________________________
