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Please
fill out, and have
Department
Head sign and
date.
Send
completed report to
Security
Department
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LOST KEY
FORM
Name of person missing
key(s):___________________________Department/room #:_______________
Missing key information
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OFFICE/ROOM NAME
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KEY CODE (IF KNOWN)
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REMARK
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Date of Key(s) Loss: ____________
Explanation of how loss occurred:
_________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Date loss was reported to Security Department:
____________________
Department Head Signature:
Date:
Location where keys were lost: Location lost/stolen:
Request
for Keys
Requestor’s
Name:___________________________________________
Unit/Department:____________________________________________
Unit
Head (Print):___________________________________________
Unit
Head (Sign):_________________________________________
Other
required approval:_____________________________________
Phone:____________________
Date:_______________________
Room
#/Description: Key #
(For Office Use Only)
__________________________________ __________
__________________________________ __________
__________________________________ __________
I
acknowledge that I have received the above requested keys
Date:_____________
Signature:________________________________
Key Return
Receipt
Name:______________________________________________________
Unit/Department:___________________________________________
Received
By (Print):_________________________________________
Date:_____________ Signature:______________________________
Room
#/Description: Key
#
(For
Office Use Only)
__________________________________ __________
__________________________________ __________
__________________________________ __________
I
acknowledge that I have returned the above listed keys
KEY REQUEST/ LOST/ STOLEN OR RETURN FORM
KEYHOLDER NAME: --- KEYHOLDER PHONE #:
POSITION: DEPARTMENT:
EMPLOYEE / STUDENT ID #: EMAIL ADDRESS
DEPT. CONTACT: CONTACT PHONE #
---()KEY REQUEST
All key requests require a Department Head signature.
Generally, it takes about 3 business days to process a Key Request and make the key.
You will be called when your key is ready. Only the person for whom the key was requested will be able to pick it up unless
previous arrangements are made. A picture ID is required.
Department Head Name : Date: Ext:
Department Head Signature: Date:
KEY INFORMATION
-Building Name
(Please do not abbreviate) -
-Building Room
-Key Number
If requesting a cabinet key, enter
numbers on the lock.
-HOOK #
(office use only)
---()LOST / STOLEN KEY REPORT
The above key(s) were lost or stolen on at/from
.
Reports of lost/stolen keys are forwarded to: MAIL STOP
Dept. Head
Dean of the School
University Security 1291
Risk Mgmt. 1240
VP of Finance & Admin 1200
KEY RETURN
No signature is required. Please complete the information above & tape the keys to the form.
OFFICE USE ONLY
TRANSACTION COMPLETED BY DATE
Updated
1-Key Receipt Form
The
following keys were issued to _________________________ on __________.
Name Date
List
all keys:
1.
two house keys
2.
two mailbox keys
I
understand that it is against Agency policy to have any of the above keys
duplicated without written permission from the Executive Director. I further understand that I am obligated to
return all keys issued to me at termination of lease.
Tôi hiểu rằng đó là chống lại chính sách cơ quan để có bất cứ phím trên nhân đôi mà không cần sự cho phép bằng văn bản của Giám đốc điều hành . Tôi cũng hiểu rằng tôi có nghĩa vụ phải trả lại tất cả các phím cấp cho tôi lúc chấm dứt hợp đồng thuê.
____________________ ________________________
Tenant
(Signature) Manager/Owner
2-Lost Key Report Form
Please type this form, print, obtain required signature(s) and mail or fax to the Access Control Center
Reporters Information:
Name: Department: Phone: E-mail: Date:
Person who lost key(s):
Last - First - Middle Initial
Phone:
Key(s) Reported as lost:
Keymark is: 499A11 Serial # is: 1
Enter as: 499A11-1
Please provide a brief explanation as to(về, để) where, when and how the key(s) were lost. Please be as specific as possible:
Signature: Person who lost key(s) Signature: Key Coordinator
_________________________ _____________________
Notice:
1. You may be held liable for the costs of rekeying all affected areas and the costs of replacement of all keys to the area.
2. No replacement keys will be issued until both this Lost Key Report and a Key Request Form are completed.
3,
5,
2-Lost Key Report Form
Please type this form, print, obtain required signature(s) and mail or fax to the Access Control Center
Reporters Information:
Name: Department: Phone: E-mail: Date:
Person who lost key(s):
Last - First - Middle Initial
Phone:
Key(s) Reported as lost:
Keymark is: 499A11 Serial # is: 1
Enter as: 499A11-1
Please provide a brief explanation as to(về, để) where, when and how the key(s) were lost. Please be as specific as possible:
Signature: Person who lost key(s) Signature: Key Coordinator
_________________________ _____________________
Notice:
1. You may be held liable for the costs of rekeying all affected areas and the costs of replacement of all keys to the area.
2. No replacement keys will be issued until both this Lost Key Report and a Key Request Form are completed.
3,
LOST KEY FORM
ADMINISTRATION DEPARTMENTAL
REPORT
To be filled out by
person who lost the key:
Key
Holders Name: ______________________________
Key
Holders email adress: ___________________________
CWID Number: _________________________
Room
Number(s): ___________________________ Key Number(s): ______________________
Circumstances
surrounding loss:
__________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
To be filled out by
department, lab supervisor or director as appropriate:
Recommendation
or Comments _____________________________________________
Re-key
Lock: No _____ Yes _____
If
Yes: Account Number for charges given _______________________________________
Individual
Fined: _________________________
To be filled out by
Building Representative:
Ordered
Replacement Key: No _____ Yes _____ - New Key Number: _________________
Date:
______________________
Total
Charges (who, what, when etc): ______________________________________________________
_____________________________________________________________________________________
Notes:
_______________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Processed
By: _______________________________ On: _________________________
**
Attach any and all communications to the back of sheet and file **
4,
LOST OR MISSING UNIVERSITY KEY REPORT FORM
Reporting Person Information
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__________ ____________
______________________ ______________________
Last Name
First Name Department
______________________________________________ _______________ ______________________________________
Address Room Number Phone
Key Information
|
_____________________________
__________________________________________________________________________
Key Number Area/Room
Accessed By Key
_____________________________
_________________________________________________________________________
Key Number Area/Room
Accessed By Key
_____________________________
_________________________________________________________________________
Key Number Area/Room
Accessed By Key
Details Regarding Lost / Missing Key:
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
I certify
that the above information is true and correct
_______________________________________________
______________________________
Reporting Person Signature
Date
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UTA PD Departmental Use Only
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______________________________
________________________________ _________________________________
Date Reported Time Reported Call Taken /IC#
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5,
KEY RECEIPT FORM
I,
, hereby accept the key(s) to and
general classroom key number .
It is understood that I shall report lost or stolen key(s) within 24 hours;
that I shall not duplicate any key(s) in any way or form; that I shall not lend
this key(s) to any unauthorized personnel; shall pay a non-refundable charge of
$25.00 for replacement of lost key(s); and, upon separation from College
employment, my key(s) shall be turned in before my final paycheck is issued.
Employee Signature
Date
(A copy of this
key receipt form is to be forwarded to the Manager of Facilities)
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