Fillable REQUEST ACCESS TO PURDUE NORTHWEST FACILITIES Job Classification (Purdue University Northwest)

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REQUEST ACCESS TO PURDUE NORTHWEST FACILITIES Job Classification (Purdue University Northwest)

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The REQUEST ACCESS TO PURDUE NORTHWEST FACILITIES Job Classification (Purdue University Northwest) form is 1 page long and contains:

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Country of origin: US
File type: PDF

U.S.A. forms for Purdue University Northwest

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REQUEST ACCESS TO PURDUE NORTHWEST FACILITIES
Name of Requester: _____________________________________________ Department: ______________________
Job Classification (Please Choose One) Faculty Staff LT Grad Assist Student Worker Temp
Policy prohibits student employees from possessing University Keys, Card access request will still be allowed on Hammond Campus
Building Room# Cabinet# Hook# Key Number
Exterior Door
Requesters' Signature ______________________________________________ Date: ___________________________________
Approved by Department Head: By adding my signature, I verify that the requester is classified as a faculty/staff employee of
Purdue University Northwest.
Department Head ________________________________ Signature ________________________ Date_______________________
Requestor….. By my signature, I understand that keys and/or access card issued to me are my personal responsibility and I agree to
not loan any key and. /or access and I further agree to personally return all keys and/.or access to the Issuing department upon
termination of employment. I also understand that in the event any key assigned to me is lost or stolen, I am responsible to
immediately notify my supervisor and the issuing facility. I also agree to pay the following fines to cover replacement cost of each
key and/or access card that is lost, stolen or not returned upon termination of employment.
Access Card $15.00 Grandmaster/Exterior Door Key $50.00 Room/Sub Master $25.00
Additional Note: Keys/cards lost or loaned may result in denial of access or replacement.
Once completed and signed, forward form to the Facilities Service office at PNWfixit@pnw.edu.
Keys, approved for distribution, may be picked up at Facilities Services on the Hammond Campus and
Westville Campus, 8:30am - 4pm Monday - Friday, and with 2 business day’s notification.
Justification required for Grandmaster Request:
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Signed authorization is required for all Grandmaster access
Hammond Campus
_________________________________________ Date
____________________________
Director Brian Miller
Westville Campus
________________________________________ Date ________________________________
Senior Director of Facilities & Grounds Scott Parsons
Updated 7-31-19
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REQUEST ACCESS TO PURDUE NORTHWEST FACILITIES Job Classification (Purdue University Northwest)

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Completed 16 August 2020

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