REQUEST FOR SANITIZATION OF DATA STORAGE DEVICE
Requestor: Date:
Title
Department
Justification for Data Sanitization
No more than 10 items per record (submit additional record if needed).
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State Tag No./ *Serial No. |
For OIT Use: Results |
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*When item does not have a State Tag No., provide Serial No. of item.
________________________________________ _______________________________________
Requestor’s Signature Date Department Head’s Signature Date
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Certification: My signature certifies that the above computer/data storage device(s) have been properly sanitized.
_______________________________________ ___________________________________________
Authorized Sanitizing Technician Date Authorized IT Supervisor/Computer Lab Supervisor Date
Form 1822/009 (6/05)
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