Request for Access Changes or Return of Access

Please provide the following information

First Name

Last Name

Employee/ Student ID:

Department

Tel. Extension #

Current Office #:

uOttawa Email:

Supervisor

Moving ?

Yes

New Office #

Moving Date:

Type of request:

Type

Access Card

Key

Return of Keys or Access Card

Please indicate all keys (ID stamped on keys) being returned and/or access card number:

Description of Request:

Please fill in the following fields, and include all areas, rooms, buildings and hours requested:

Other:

Please read this important information:

You are personally responsible for your access card and any keys that you have. If you lose your card and/or keys, or if they are stolen, you must immediately report the incident to the card administrator of your department or to Protection Services.
Never lend your access card or keys, or allow unauthorized persons to enter an area for which they don’t have a card or keys. Ask them to contact Protection Services.
Cards used in unauthorized areas or used outside a specific time frame will activate an alarm.
A door held open for more than 120 seconds will cause an alarm.
Unauthorized persons found in access controlled areas should be reported to Protection Services.
At the end of your time at the University of Ottawa, keys and cards must be returned to your administrative office.
If you move office/lab, you are required to return your key(s) to your former space. Please return them to your administrative office. You will not be granted access to your new space until you have returned them.

Confirmation and Authorization

I, (Your name)

Confirmation

I have read and confirm that I understand the rules and instructions governing the University of Ottawa access card system. I recognize that both Protection Services and my service or academic unit managers reserve the right to cancel my card if I fail to follow the rules and instructions above.

Authorization to Access other Department of Core Facilities

Manager's Name:

Department's/Core Facilities Manager's Name:

Date

What to do with this form?

Once this form has been filled out electronically, printed and signed, the form can be handed in to your administrative office.

For personnel in Biochemistry, Microbiology and Immunology (BMI): RGN 4103
For personnel in Cellular and Molecular Medicine (CMM): RGN 3206
For personnel in Kidney Research (KRC): RGN 2527
For personnel in Neuroscience (NRI): RGN 1114
For personnel in Pathology: RGN 4155
For personnel in Epidemiology (EPI): 600PM, Room 101G
For personnel in Health Sciences (HSC):
- Keys: MNT 407C
- Access card: RGN 1114

For Office Use Only:

Keys Returned

Date

Keys handed out

Date