Facility Entry Scan Registration Form
Facility Entry Scan Registration Form for logging and tracking facility access. Please complete all fields accurately.
Full Name
*
First Name
Last Name
Organization/Department
*
Contact Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
example@example.com
Date of Entry
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Time of Entry
*
Hour Minutes
AM
PM
AM/PM Option
Entry Location
*
Please Select
Main Entrance
Loading Dock
Employee Entrance
Visitor Lobby
Other
Scan Type
*
ID Badge
QR Code
Barcode
Manual Entry
Other
Scan Result
*
Successful
Failed
Badge or Access Number
Purpose of Entry
*
Please Select
Work/Shift
Delivery
Visitor/Guest
Maintenance
Other
Submit Entry
Should be Empty: