Facility Access Authorization Request

Table of Contents:

• Purpose:
• General Information:
• Exhibits and Instructions:
• Form Requirements:
• Number of Copies and Ultimate Distribution
• Where To Send Completed Forms
  • Access Requests WITHIN the Requesters Home Area
  • Access Requests OUTSIDE the Requesters Home Area
• Contact Information
• Cross References

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Purpose

The Facility Access Authorization Request form is used to grant authority for an individual to access University locations during times when those locations are locked. Such authorization acknowledges that the individual, to whom access is assigned, has the authority and the functional responsibility to enter those locations. The person to whom access is being granted must read and agree to comply with Policy AD68 University Access prior to receiving the access requested. This form is administered by the Access Coordinator, who will record the approval of such access requests and maintain this document in their files. This is a permanent record as long as the key(s), access device, and clearance issuances are outstanding to that individual.

General Information

• Restrictions:
• This facility authorization grants access only to the Requester named on this form.
• Access is limited to the areas approved on this form.
• Access is restricted to the specified and approved days and times.
• Access to the facility will be for the approved purpose and by the approved means, as determined by the Access Coordinator.
• Non-employees require a University-employed sponsor, and can only request temporary access. The Sponsor is responsible for all non-employee keys/ACDs.


• Lost or Stolen Keys/ACDs:
  • The loss of a key/ACD must be reported immediately to the Access Coordinator by the individual to whom the key/access card has been issued. Completion of a new form will be required.
  
  
• Access Changes:
• If access needs to be changed from those which have been granted herein, the said individual will notify the Access Coordinator for completion of a new Facility Access Authorization Request.


• Additional Information:
  • For questions pertaining to access, please refer to Policy AD68 University Access , or Procedure SY2001 University Access; Clearances, Keys and Access Devices; Authorization, Issuance and Fees.

The form must be completed by the Requester, Immediate Supervisor/Sponsor, and Access Coordinator. The Requester must read policy AD68 University Access, as well as the "AD68 Advisement Statement" and other information on the form. The Immediate Supervisor/Sponsor, and Access Coordinator will sign/date the form, affirming that the Requester has been advised of their responsibilities under policy AD68 and that they have provided a copy of the policy, if requested.

Final processing will occur as specified in "Where to Send Completed Forms," below.

Exhibits and Instructions

This form has fill-and-print form fields and digital ID (signature) fields enabled. The PDF version has instructions provided for the type and/or format of information to be included within the form fields. Hovering the computer mouse over any form field will display these instructions.

To view document exhibits, click on link below:

Facility Access Authorization Request Exhibit

Form Requirements

No form may be used that substitutes for an approved official University form without prior review and approval by the steward of the form/central office, as facilitated by the Office of Systems and Procedures (designated representative of the Associate Vice President for Budget and Finance). See Policy FN17 Required Use of Approved University Forms Appearing in the General University Reference Utility (GURU) and Procedure FN2017 Use of Approved Form Templates Appearing on the GURU Website for full details.

Number of Copies and Ultimate Distribution:

Where to Send Completed Forms:

Access Requests WITHIN the Requesters Home Area

The form is forwarded to the requesting department's Access Coordinator. The requesting department's Access Coordinator will review the request, and if acceptable, sign and date, affirming that they have reviewed the details of the access request and they concur with the request for access.

Access Requests OUTSIDE the Requesters Home Area

The form is forwarded to the requesting department's Access Coordinator. If the request is outside the Requesters home area, the Requesters Home Area Access Coordinator must contact the Access Coordinator of the facility to which access is being requested for permission to access the facility. The discussion and decision to grant access (or not grant) must be substantiated through the exchange of a confirming email between the requesting department's Access Coordinator and the Access Coordinator of the facility to which access is being requested. Once granted and confirmed, the requesting department's Access Coordinator will sign and date, affirming that they have reviewed the details of the access request and access permission has been authorized. If permission is not granted, the form will be retained as evidence of the decision. Copies of the confirming or denial emails (as applicable) must be retained by the both Access Coordinators involved for proper audit trail.

Once approved, and prior to receiving the appropriate access device from the requesting department's Access Coordinator, the Requester must sign and date, affirming that they have been advised of policy AD68, are aware of their responsibilities in receiving access, and that in accepting keys and/or ACDs from the Access Coordinator, agree to comply in full with the terms specified on the form and all related University policies. The Access Coordinator will issue the access devices requested to the Requester, along with a signed copy of the form. A signed copy of the form will also be provided to the department/company requesting the issue. The Access Coordinator will retain the signed, original copy of the form for their records. For access requests OUTSIDE the Requesters home area, a signed copy of the form will be forwarded to the Access Coordinator of the facility being accessed.

Contact Information

For questions, additional details, or to request changes to this form, contact your Access Coordinator.

Cross References

• Policy AD35 University Archives and Records Management
• Policy AD68 University Access
• Policy FN17 Required Use of Approved University Forms Appearing in the General University Reference Utility
• Procedure FN2017 Use of Approved Form Templates Appearing on the GURU Website
• Procedure SY2001 University Access; Clearances, Keys and Access Devices; Authorization, Issuance and Fees

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