Facility Access Handover Certificate Form
Use this form to record the transfer of facility access items and confirm responsibility has been handed over.
Handover Parties
Facility Name / Location
*
Handover Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Current / Previous Holder Full Name
*
First Name
Middle Name
Last Name
Current / Previous Holder Role / Title
*
New Responsible Person Full Name
*
First Name
Middle Name
Last Name
New Responsible Person Role / Title
*
Access and Asset Handover
Access Items Being Handed Over
*
Keys
Access Cards
Badges
Fobs
Alarm Codes
Facility Access Codes
Other
Condition / Status at Handover
*
Please Select
New
Good
Fair
Damaged
Not Working
Other
Remarks / Exceptions
Handover Confirmation
Signature of Current Holder or Authorized Representative
*
Submit
Submit
Should be Empty: