Facilities Management

Key Authorization Form (revised 11/03)

(return to: Facilities Management or Key Policies)

Date: ____________________

Name: ___________________

Department: _____________________

Check one:

[ ] Student

[ ] Staff

[ ] Faculty

[ ] Other ______________________

*Supervisor's Authorization: __________________________ (Signature required)

Building Manager's Authorization: _____________________ (Signature required)

Date to be Returned: _________________________________

Building Room Number Key No. (if known)

1. ________________
________________ ________________

2. ________________
________________ ________________

3. ________________
________________ ________________

4. ________________
________________ ________________

5. ________________
________________ ________________

6. ________________
________________ ________________

* This person is responsible for collecting and returning keys to the Facilities Office if the person who was originally issued the keys does not turn them in to the Facilities Office.

Date: ____________________

Name: ___________________		Department: _____________________

Building	Room Number	Key No. (if known)
1. ________________	________________	________________
2. ________________	________________	________________
3. ________________	________________	________________
4. ________________	________________	________________
5. ________________	________________	________________
6. ________________	________________	________________

Facilities Management

Key Authorization Form (revised 11/03)

This page is maintained by B. Ray.