Workstation Privacy Shield Enrollment Form
Complete this form to enroll for a workstation privacy shield in your workplace.
Employee Full Name
*
First Name
Last Name
Employee Email Address
*
example@example.com
Department
*
Please Select
Human Resources
IT
Finance
Operations
Sales
Marketing
Other
Workstation Location or ID
*
Type of Privacy Shield Requested
*
Please Select
Standard 21" Monitor Shield
Wide 27" Monitor Shield
Laptop Privacy Shield
Other (please specify)
Reason for Requesting a Privacy Shield
*
Supervisor/Manager Name
*
First Name
Last Name
Supervisor/Manager Email
*
example@example.com
Date of Request
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Asset Tag/Inventory Number (if applicable)
Additional Comments or Special Instructions
Submit Enrollment
Should be Empty: