Full Text
SECURITY ACCESS AUTHORIZATION REQUEST PLEASE PROVIDE AS MUCH INFORMATION AS POSSIBLE DATE OF REQUEST: o IDENTIFICATION ONLY – NO ACCESS TYPE: o NEW o CHANGE OF EXISTING o REPLACEMENT – IDENTIFY: LOST, STOLEN, DAMAGED, oPERMANENT ACCESS (UNTIL REMOVED FROM SYSTEM) oLIMITED ACCESS FROM TO LAST NAME: HEIGHT: FIRST NAME: WEIGHT: MIDDLE INITIAL: EYE COLOR: DL # OR EMP ID HAIR COLOR: ORGANIZATION: POLICE ID: ADDRESS: PHONE: CARD ACCESS REQUESTED: o CARD KEY o ALARM CODE o KEY o FUEL KEY BUILDING(S): o MUNI o FPSC o PUB WORKS oPARKS SHOP o HUB o BIC o MT OGDEN o JUSTICE COURT o ALARM CODE FOUR DIGIT PIN NUMBER (CHOSEN BY INDIVIDUAL RECEIVING ACCESS) o TEMPORARY, SEASONAL, OR VOLUNTEER o AUTHORIZED CONTRACTOR o OUTSIDE AGENCY (FIRE, POLICE, ETC.) o OTHER. PLEASE SPECIFY: REASON FOR ALLOWING ACCESS: SIGNATURE OF INDIVIDUAL AUTHORIZING ACCESS: PRINTED NAME: TITLE*: *DIVISION MANAGER, DEPARTMENT HEAD, CAO, MAYOR, OR COUNCIL EXECUTIVE ADDITIONAL AUTHORIZATION: IF ACCESS IS BEING REQUESTED FOR AREAS UNDER THE AUTHORITY OF ANOTHER EXECUTIVE, ADDITIONAL SIGNATURES ARE REQUIRED: SIGNATURE OF INDIVIDUAL AUTHORIZING ACCESS: PRINTED NAME: TITLE*: MUNICIPAL BLDG FRANCOM PUBLIC SAFETY PUBLIC WORKS JUSTICE COURT FLOOR ACCESS FLOOR GEN HRS AFTER HRS FLOOR GEN HRS AFTER HRS FLOOR GEN HRS AFTER HRS EMP GENERAL ACCESS (BUS HOURS) FIRE #1 – ADMIN BLDG #1 – OPS PROSECUTOR’S OFC AFTER HRS ACCESS: FIRE #2 – BATT CHIEF BLDG #1 – OPS OFFICE JUDGES CHAMBERS FLOORS 1-3 GEN FIRE #3 – CAPTAINS BLDG #1 – WATER CREW HALLWAY/JURY ADD 4TH FL ELEV. FIRE #4 – FIREFIGHTER BLDG #1 – WATER OFFICE CLERKS OFC W/COMP RM POLICE #1 – ADMIN BLDG #6 – FACILITY CREW BAILIFF ADD 5TH FL + ELEV. POLICE #2 – LTS BLDG #8 – MECHANICS HOLDING AREAS ADD 6TH FL + ELEV. POLICE #3 – SGT/PATROL BLDG #8 – PARTS JANITORIAL ADD 7TH FL + ELEV. POLICE #4 – RECORDS BLDG #8 – ADMIN ADD 8TH FL + ELEV. DISPATCH JANITORIAL ADD 9TH FL + ELEV. SWAT ADD 10TH FL + ELEV. COMM TECH AMPHITHEATER ADD + ELEV. WATER SITES ADD RECORDS MAILROOM JANITORIAL ADDITIONAL ALARM ACCESS: OFFICE USE ONLY CARD KEY FUEL KEY KEY(S) DENCO LIST UPD AVIGILON