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SECURITY ACCESS AUTHORIZATION REQUEST PLEASE PROVIDE AS MUCH INFORMATION AS POSSIBLE DATE OF REQUEST: IDENTIFICATION ONLY – NO ACCESS TYPE: NEW CHANGE OF EXISTING REPLACEMENT PERMANENT ACCESS (UNTIL REMOVED FROM SYSTEM) LIMITED ACCESS: FROM TO LAST NAME: HEIGHT: FIRST NAME: WEIGHT: MIDDLE INITIAL: EYE COLOR: ORGANIZATION: HAIR COLOR: ADDRESS: POLICE ID: PHONE: DL# OR EMP ID#: ACCESS REQUESTED: CARD KEY ALARM CODE KEY FUEL KEY BUILDING(S): MUNI FPSC PUB WORKS PARKS SHOP HUB BIC MT OGDEN JUSTICE COURT ALARM CODE FOUR DIGIT PIN NUMBER (CHOSEN BY INDIVIDUAL RECEIVING ACCESS) TEMPORARY, SEASONAL, OR VOLUNTEER AUTHORIZED CONTRACTOR OUTSIDE AGENCY (FIRE, POLICE, ETC.) OTHER. PLEASE SPECIFY: SIGNATURE OF INDIVIDUAL AUTHORIZING ACCESS: PRINTED NAME: *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: 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 CARD KEY FUEL KEY KEY(S) DENCO LIST UPD AVIGILON 0 0 SIGN SIGN Print Form Submit Form Reset Form