Get Key Request Form Template

Key Request Form KEY REQUEST FORM Date Name Last Name First Name MI City State LBCC ID X Address Home Street Department Staff Faculty Zip Other Access Needed to the Following Areas Key Holders Signature By checking out key s you are assuming responsibility for them. The key s should remain in only your possession. If lost or stolen you must report this information to the Safety Loss Prevention Department. Upon separation from LBCC you are responsible to return the key s to the Public Safety office RCH 119. Employee s signature authorizes LBCC to charge a rekeying fee of 50. 00 per key that is lost stolen or not returned upon termination of employment. Authorizer - Printed Name Director Dean Vice President or President For Grand Master keys only the President can authorize distribution* For all other keys including Building Masters Area Masters and/or Room Keys the President Vice Presidents or Respective Dean/Directors not Assoc* Deans can authorize distribution* If Dean/Director is not available the form would need to be signed by a Vice President. An individual cannot authorize his/her own keys. Key Sequence Keys Picked Up By Date Issued Date Returned Bring to Public Safety office RCH 119 to receive key s. Upon separation from LBCC you are responsible to return the key s to the Public Safety office RCH 119. Employee s signature authorizes LBCC to charge a rekeying fee of 50. 00 per key that is lost stolen or not returned upon termination of employment. Employee s signature authorizes LBCC to charge a rekeying fee of 50. 00 per key that is lost stolen or not returned upon termination of employment. Authorizer - Printed Name Director Dean Vice President or President For Grand Master keys only the President can authorize distribution* For all other keys including Building Masters Area Masters and/or Room Keys the President Vice Presidents or Respective Dean/Directors not Assoc* Deans can authorize distribution* If Dean/Director is not available the form would need to be signed by a Vice President. Authorizer - Printed Name Director Dean Vice President or President For Grand Master keys only the President can authorize distribution* For all other keys including Building Masters Area Masters and/or Room Keys the President Vice Presidents or Respective Dean/Directors not Assoc* Deans can authorize distribution* If Dean/Director is not available the form would need to be signed by a Vice President. An individual cannot authorize his/her own keys. Key Sequence Keys Picked Up By Date Issued Date Returned Bring to Public Safety office RCH 119 to receive key s. Upon separation from LBCC you are responsible to return the key s to the Public Safety office RCH 119. Employee s signature authorizes LBCC to charge a rekeying fee of 50. 00 per key that is lost stolen or not returned upon termination of employment. Authorizer - Printed Name Director Dean Vice President or President For Grand Master keys only the President can authorize distribution* For all other keys including Building Masters Area Masters and/or Room Keys the President Vice Presidents or Respective Dean/Directors not Assoc* Deans can authorize distribution* If Dean/Director is not available the form would need to be signed by a Vice President.