Westminster College Key Request

Please complete one form per person per key (s).

* indicates a required field.

       
* Name of key recipient:  
* Date:  
* Please choose one...  
  Name of key requestor if (different than person receiving key):  
* Is this a new position?  
  If no, state the disposition of the previously issued keys:  
* Room name and number for which key is requested:
 
* Reason for key requisition:  
* Number of keys requested:  
I understand this key is the property of Westminster College and its loss must be reported immediately to Campus Security. I agree to accept all responsibilities associated with this key and will not duplicate or transfer this key to any other person. I will surrender it to the Office of Human Resources when I no longer have a need for the key and/or end my employment at the college.
* Electronic Signature of the person receiving the key(s):  
* If this request is to replace lost/stolen key(s), has the Security Department been notified and an incident report prepared? (please include the incident number)
 

Please fill out this section ONLY if key(s) have been lost or stolen.

Lost/Stolen Key(s)

  Building...  
  Room/Area... (include building name and room number)
 
Action requested:
  Action requested:  
  Action Requested by:  

To be filled out by the Safety Director.

FOR OFFICE USE ONLY

  Decision:  
  Lock change required: Yes
No
 
  Re-keying required: Yes
No
 
  Replacement key required: Yes
No
 
FOR OFFICE USE ONLY: Authorized by:
  VP  
  Dean  
  Dir.  
FOR OFFICE USE ONLY: General Information
  Cost  
  Account Number  
  Date issued:  
  Issued by:  
  Date of return:  
  Received by: