Scribd
Upload
29 views

Key Issuance Form: 1. Completed EH & S Training

This document is a key issuance form for the University of California, Irvine Integrated Nanosystems Research Facility. It requires the name, department, status, contact information, and signature of the employee or student receiving keys. It lists the building, room, key serial number, and date issued for the keys and includes an agreement that the recipient is responsible for the keys, will report any loss, and return keys upon leaving employment or school. It also notes there is a $10 fee for student keys.

Uploaded by

Adrian Toisa
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
29 views

Key Issuance Form: 1. Completed EH & S Training

This document is a key issuance form for the University of California, Irvine Integrated Nanosystems Research Facility. It requires the name, department, status, contact information, and signature of the employee or student receiving keys. It lists the building, room, key serial number, and date issued for the keys and includes an agreement that the recipient is responsible for the keys, will report any loss, and return keys upon leaving employment or school. It also notes there is a $10 fee for student keys.

Uploaded by

Adrian Toisa
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 1

Date____________________

UNIVERSITY OF CALIFORNIA, IRVINE, INTEGRATED NANOSYSTEMS RESEARCH FACILITY

KEY ISSUANCE FORM


THIS FORM MUST BE SIGNED BY ALL EMPLOYEES AND STUDENTS ISSUED UNIVERSITY KEYS

NAME DEPT. STATUS (Circle one)


Last First FAC Vis Fac Staff
E-MAIL ADDRESS LEC Vis Lec Grad

HOME ADDRESS RES Vis Res Under


Grad

HOME PHONE OFFICE PHONE

EMPLOYEE NUMBER STUDENT ID NUMBER

The above named person is authorized to have keys to the rooms listed below.

Responsible P.I. signature Director INRF

DATE CHECK
BLDG. ROOM SERIAL # KEY NO. ISSUED DEPOSIT IN

AGREEMENT

It is understood and agreed that:

(1) I am responsible for the university key(s) issued to me and I will report its loss/theft immediately. I agree to reimburse the
university for reasonable costs necessary to replace keys or to change locks (not to exceed $150.00 per lock) in the event the
loss of key jeopardizes the security of the university spaces.

(2) The key(s) issued to me may not be reproduced except by the University of California, Irvine.

(3) The key is to be returned immediately to the Business Office, Computer Science and Engineering, Room 204 (CSE 204) on
termination of my employment or my withdrawal from school.

(4) The cost of each key will be $10.00 for students.

(5) Only enrolled students or employees will be entitled to keys.

SIGNATURE:
I understand the above agreement and take responsibility for the above listed key(s).

Signed ____________________________________________________

1. Completed EH & S Training _______________________


DATE

2. Completion of Clean Room Procedures and _______________________


Specialized Facility Procedures DATE

You might also like

pFad - Phonifier reborn

Pfad - The Proxy pFad of © 2024 Garber Painting. All rights reserved.

Note: This service is not intended for secure transactions such as banking, social media, email, or purchasing. Use at your own risk. We assume no liability whatsoever for broken pages.


Alternative Proxies:

Alternative Proxy

pFad Proxy

pFad v3 Proxy

pFad v4 Proxy