Key Checkout Form

Key Checkout Form
Key Recipient Information
Name
First NameLast Name
Department/Unit
Employee/Student ID
Email
example@example.com
Phone Number
Please enter a valid phone number.
Key Details
Key Number/Code
Issuing Authority
First NameLast Name
Date Issued
MonthDayYear
Date
Date Due for Return
MonthDayYear
Date
Key Condition
NewGoodFairPoor
Responsibilities:
- The key recipient acknowledges that they are responsible for the safekeeping of the key.
- The key must not be duplicated or shared.
- The key recipient must promptly report any loss, damage, or unauthorized access involving the key.
Acknowledgment:
I, the undersigned, have received the above-mentioned key and agree to adhere to the responsibilities and guidelines outlined in this form. I understand the importance of key security and will take all necessary precautions to prevent loss or unauthorized use.
Date
MonthDayYear
Date
Signature
Clear
Should be Empty: