Fillable Yes No (Shasta College)

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Yes No (Shasta College)

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Date:
Extension
Period Needed:
FROM: TO:
Yes No
Yes No
Rev. 05/14
Date:
Extension
Period Needed:
FROM: TO:
Yes No
Yes No
Rev. 05/14
White: Campus Safety Yellow: Department Copy Pink: Employee Copy
(AFTER OBTAINING APPROVALS, SUBMIT TO CAMPUS SAFETY OFFICE, ROOM 5015)
(AFTER OBTAINING APPROVALS, SUBMIT TO CAMPUS SAFETY OFFICE, ROOM 5015)
Division/Course
For Room(s):
Bldg Master Key Needed?
Supervisor Approval:
Division Director Approval:
Campus Grand Master Key(s)?
Additional Approval:
Refer to Policy AP-6521-Security for District Property
Key #: _____________________________________________ ID Checked by Campus Safety: _____________
Exterior Needed?
Vice Pres.-Admin Svcs. Approval:
KEY REQUISITION FORM
Vice Pres.-Admin Svcs. Approval:
Key #: _____________________________________________ ID Checked by Campus Safety: _______________
SHASTA-TEHAMA-TRINITY JOINT COMMUNITY COLLEGE DISTRICT
White: Campus Safety Yellow: Department Copy Pink: Employee Copy
Division/Course
First Name
Refer to Policy AP-6521-Security for District Property
SHASTA-TEHAMA-TRINITY JOINT COMMUNITY COLLEGE DISTRICT
KEY REQUISITION FORM
Exterior Needed?
Last Name
Supervisor Approval:
Full Time _____ Part Time _____ Other __________
Additional Approval:
For Room(s):
Last Name
Campus Grand Master Key(s)?
Full Time _____ Part Time _____ Other_____________
First Name
Bldg Master Key Needed?
Division Director Approval:
REPLACING KEY: IF BROKEN, state on form and return with broken key. A new key will be re-issued. If key is LOST or STOLEN, request appropriate form from Campus Safety. The cost
to replace a LOST or STOLEN key shall be the responsibility of the employee and must be paid prior to receiving a replacement key.
Lost/Stolen Key Fees: Electronic Key Cards - $10.00 Standard Key - $25.00 Multi-Room Key - $40.00 Master Key - $100.00
I, the undersigned, acknowledge receipt of the keys designated above. I also agree not to loan, transfer, give possession of, 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.
Signature ______________________________________________________________ Date____________________________________
REPLACING KEY: IF BROKEN, state on form and return with broken key. A new key will be re-issued. If key is LOST or STOLEN, request appropriate form from Campus Safety. The cost to
replace a LOST or STOLEN key shall be the responsibility of the employee and must be paid prior to receiving a replacement key.
Lost/Stolen Key Fees: Electronic Key Cards - $10.00 Standard Key - $25.00 Multi-Room Key - $40.00 Master Key - $100.00
I, the undersigned, acknowledge receipt of the keys designated above. I also agree not to loan, transfer, give possession of, 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.
Signature ______________________________________________________________ Date____________________________________
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Yes No (Shasta College)

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Completed 25 July 2020

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