REQUEST FOR BUILDING KEYS
All Keys requested must be authorized by the designated agency staff Supervisor or Facility Manager prior to issuing. This form must be completed when requesting/issuing keys.
PRINT Name of Employee:
Department: Position or Title:
Building:Work Phone:
Immediate Supervisor: Phone:
Key number/symbol/letter Quantity Description of area for use (what door(s)
will this key open) or Room # and Floor

$$ REPLACEMENT FEE $$
Key(s) issued to an employee will not require a deposit fee. However, any key(s) lost or stolen while in custody of an employee will require a $50.00 replacement fee per key assessed to the agency for which the employee works. Broken or damaged key(s) turned in may be exchanged for new ones upon approved application, without charge.
Complete Account Code: Fund Agcy Org ObjTo charge key replacement to

RETURN OF KEY(S) AT TERMINATION
At the time of termination, those employees having a record of a key issued to them will be required to return all keys before final clearance will be given. In cases where employees are unable to produce keys charged out to them, a joint evaluation by the employee's department head and the locksmith will be made and a fee commensurate with the cost incurred by the state to replace the key(s) or change the lock(s) will be assessed.

EMPLOYEES AGREEMENT
  1. I will not loan out the key(s)
  2. I will not alter the key(s)
  3. I will use the key(s) for the intended purpose only
  4. Agency's fee for lost key = $50.00 for each key not returned.
  1. I will not have key(s) duplicated
  2. I will store key(s) safely
  3. I will immediately report lost or stolen key(s) to my authorized
    agency
I UNDERSTAND AND AGREE TO THE ABOVE STATEMENTS
Employee Signature: Date:
Authorized Agency Signature:
Additional Signatures as needed: