KEY CONTROL FORM
Date: __________________
_________________________________ ________________________________
Name of Employee Campus/Department
_________________________________ ________________________________
Title of Employee Phone
Please issue above employee key(s) to the following areas (include precise building, room numbers):
Approved: _____________________________ _______________________________
Signature of Department Head Title
_____________________________ _________________________________
Key Control Manager Date
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Issuance of Keys- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
I acknowledge receipt of the key(s) described above. I understand that all keys are property of the College and it is a violation of College policy to duplicate or to have duplicated any key issued by the College. I further acknowledge responsibility and accountability for this key(s). I will report loss or theft of the key(s) to Campus Police immediately and will return key(s) to my department head at time of separation, termination or retirement from the College. I further agree to remain knowledgeable of and abide by the College’s Controlled Access policy while in possession of the key(s).
__________________________________ _________________________________
Employee’s Signature Date
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Return of Key(s)- - - - - - - - - - - - - - - - - - - - - - - - - - - -
The above key(s) has been returned to the Key Control Manager.
__________________________________ _________________________________
Signature of Key Control Manager Date
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Issuance of Replacement Key(s)- - - - - - - - - - - - - - - - - - - - -
The above key(s) have been lost or stolen. Replacement keys have been issued to the employee.
__________________________________ _________________________________
Signature of Employee Date
__________________________________ _________________________________
Signature of Key Control Manager Date
Form 1370/001 (7/03)