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Facilities Management Key Request

DateRequested:__________________________________DateReceived:__________________

RequestersTitle___________________________________ ASUID:________________________

Name:___________________________________________ Contact#_______________________

RequestersDepartment:________________________________________________________________

FOAP:____________________________________________________________ ___________________

Key Information

Building:__________________________  Room/Door#:_____________________

Key#(Ifknown):__________________________ _____________________________________________

NewKeyCutorRe‐assign:_______________________________________________________________

OldKeyHolderName(IfKnown):_________________________________________________________

I,theundersigned,byacceptingtheidentifiedkey,herebyagreetotakediligentcareandpromptlyreportandloss

thereof.Ifurtheragreenottogivepossessionofsaidkeytoanyotherperson,norcauseorallowanycopiestobe

madeofsaidkey.Iunderstandthatanyviolation

ofthisagreementmayresultindisciplinaryactionbythe

Administrationofthisinstitution.

Estimatedreplacementvalueofthiskeyis$25perlockthatkeyoperates.



EmployeeSignature:_________________________________________ __________________________

Dept.Chair/Supervisor:________________________ ________________________________________

Dean/Director:________________________________________________________________________



FacilitiesUseOnly



CoreMark:____________________   KeyLevel:________________________



Key#:________________________  WorkOrder#:____________________



KeyWay:B/RC________________



FM:___________________________________________________Date:_____________________



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Facilities Management Key Request (Arkansas State University)

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