Security Access Request Form

For questions, please contact or 850-644-3810. NOTE: Security access is granted only after allcompliance issues are met. Please type (when possible) or print neatly and submit (with authorized signatures) to room 118 Dittmer Building.
REQUESTER’S INFORMATION
Employment Group: / FACULTY / A&P / USPS / OPS / STUDENT / VISITOR
NAME: / EMAIL:
PHONE #: / FSU card # FSU SN #
SUPERVISOR’S INFORMATION & APPROVAL
NAME / SIGNATURE:
KEY REQUESTS (The approver is the faculty member assigned to the space by the Chemistry Space Committee) / SWIPE CARD ACCESS TO PERIMETER DOORS [cCure]
Requester Initials/date / *Approver’s Initials/date / Room# - Bldg
(example: 114-DLC) / Requester Initials/date / Approver Initials/date / BUILDING ENTRANCE DOORS
DLC, external doors, Bldg 38
CSL external doors, Bldg 4008
Fisher Lecturer Hall—Prep Room only
CSL conference rooms (except 5002)
LOCKNETICS CARD SWIPE ACCESS [secure laboratories or offices]
Requester Initials/date / DOOR / APPROVER / SIGNATURE /DATE
DLC-118-Administrative Office / Debra Baxley
DLC-316 Academic Office / Elizabeth Kistner
DLC-128 – Stockroom / Debra Baxley
CSL-116- BASS/MACLabs / Bert van de Burgt or Umesh Goli
CSL-1009/5100-NMRLab / Banghao Chen
CSL-1008 EPR Lab / Bert van de Burgt
CSL-1011-MS/Xray Lab / Bert van de Burgt
DLC-703 NMR Lab / Banghao Chen
DLC-10 MASS SPEC Lab / Umesh Goli
DLC-12 NMR Lab / Banghao Chen
MASTER KEYS: require fingerprint background clearance and approval by the Chemistry Department Chair
DLC / HTL / CSL / APPROVED / DISAPPROVED
CHAIR SIGNATURE:
COMPLIANCE REQUIREMENTS
Date training completed / Security Manager Initials/Date / Completion of EH&S training is required
FSU EH&S: Classroom based course (Hazardous Waste Awareness/Introduction to Laboratory Safety/Hazard Communication), calendar/sign-up
FSU EH&S: Hazardous Waste on-line Refresher
I understand that I am responsible for the security access provided to me. My access is for my sole use only and I will not use my access for others. Because security access is attached to my FSU ID card, I also understand that I am responsible for it and any keys issued to me. Lost or stolen FSU ID cards must be reported immediately to the FSU ID card center ( Lost or stolen keys must be reported to the FSU Police immediately ( 644-1234), a copy of the police report must be provided prior to re-issuance of a replacement key. I will notify the security manager of my termination of employment from FSU Department of Chemistry and Biochemistry. By signing and dating this form, I acknowledge that I have read and agree to abide by all policies and procedures.
Requester’s signature: / Date:
THIS SECTION TO BE COMPLETED BY THE SECURITY MANAGER (Deb or Clint)
Date submitted to security or key bank / K=Key
S=Swipe / Building / Room / Comments / Date Access terminated

Florida State University Key Issuance Policy

  1. University Police must have unrestricted access to all campus areas for safety, security and health reasons, through the establishment and maintenance of a master keying system. Any request for keying off the master system must be submitted in writing, with justification to the Supervisor Facilities Key Shop.
  1. All employees of Florida State University will be assured access to their workspace. In most situations, keys will be issued directly to employees. As key holders, individuals will assume responsibility for safekeeping and eventual return of university keys. Any request for key duplications must be submitted to, coordinated and performed by the FSU Key Shop. Any other method of duplication is prohibited.
  1. Keys will not be issued to students or student employees, except as provided for in the key policies. A Dean, Director, or Department Chair may authorize temporary key access to a student employee within a department, through the Key Manager/Security Access Representative, and will assume responsibility for its use.
  1. A Key manager/Security Access Representative will be designated for each building and/or department. One of the responsibilities of the position will be the supervision of key transactions.
  1. Actual key issuance and collection, along with related key form paperwork and record keeping will be handled within departments by the Key Manager/Security Access Representative. The Key managers/Security Access Representatives will act as department liaisons between the Facilities Key Shop and building occupants.
  1. Lost or stolen keys will not be replaced until a report has been filed with University Police.
  1. Key Managers/Security Access Representatives are appointed by a Dean, Director or Department Chair in writing to the Facilities Key Shop. Key Managers/Security Access Representatives must be USPS/A&P employees.

I have read and agree to abide by this policy:

Signed:______Date:______

Revised 12.11.2013Page 1