Hamilton Health Sciences

Information & Communication Technologies Department

Computer Access Request Form

ICT Computer Access Request Form

All fields are mandatory, if not fully completed by a Director, Manager, Supervisor or Clinical Educator it will be returned and not processed.

First Name: Last Name:

Employee I.D. Number: Phone Extension:

Job Title: Discipline:

Program or Department: Site:

Manager’s Name: Manager’s Title:

Ext:

Please Check:

New Access Modify Existing Access - list username

Email NT Network Access only, not including Email.

Meditech:

Clinical Stores Access Purchasing Access

If you require Material Management - Stores and Purchasing Access, list cost center(s) If you are requesting purchasing access, please ensure you have updated the “Signing Authorization Form” with Finance. Access will not be granted if this has not been completed.

IWT Workload include preferred ward. Ward

Sovera for HIM Retrieval No Print Retrieval Print Physicians – staff only

Other Health Records staff only – specify template

Peoplesoft:

HRMS Time & Labour only Manager Access Recruitment Access Other (specify)

** NOTE: IF THIS ACCESS IS REQUIRED FOR OVERTIME APPROVAL, REQUESTOR MUST BE A DIRECTOR OR MANAGER**

This account is replacing:

*Name: *Username:

* Note: The fields above are required information. If requesting a new Peoplesoft HRMS account, you must indicate a corresponding account to inactivate. If special circumstances require additional accounts in your area, please describe those circumstances here.

**For Peoplesoft HRMS access, this form will be forwarded to HR Applications Assistance for approval.

Financials General LedgerQuery Reporting

Other Applications – list here:

If you are not sure of Access required, list the name of an employee who currently has this application and access. If there is more than one application, list ALL of the applications required.

Application name:

Employee name:

Non HHS Employees

If you are not an HHS employee, please list employer’s name, address and phone number in space below. Authorization is required from a Manager, Supervisor or Clinical Educator.

Name:

Job Title:

Program or Department:

Phone Extension:

This form must be emailed by an authorized Requestor or authorized delegate to Password Admin on the Global Address List or . If email is not available please call the ICT Helpdesk at Ext 43000. Please do not send this form in Interoffice Mail.

January 2006