Special Duty Request
Campus Security
Department
Updated10/09/2019
Requested by:
Requested by phone #:
Date of request:
Nature of event: Location:
Date of event: Start time of event:
End time of event:
Employee in charge/Title: Employee in charge telephone #:
Dept. contact info: Billing account #:
Billing rate for security officers: Officer @ $ 27.57 plus fringe
Number of Security Officers requested:
Start time: End time:
Start time: End time:
Start time: End time:
Specific duties of requested security officers:
Please answer the questions below.
Requested Police officers?
Yes or No
If yes, how many Police Officers?
Event broadcast to public?
Yes or No
Students only?
Yes or No
Event open to the public?
Yes or No
Students & guests only?
Yes or No
Alcohol to be served?
Yes or No
Expected attendance:
To be completed by Supervisor To be completed by employee in charge after event:
Name of security personnel assigned to the event Actual start time Actual end time Approving initials
1)
2)
3)
4)
5)
6)
Please save and submit completed form to: uhhsafe@hawaii.edu
For assistance, please call Campus Security at 974-7911.
