NORTH CAROLINA AGRICULTURAL AND TECHNICAL STATE UNIVERSITY
PHYSICAL PLANT
KEY AND LOCK REQUISITION
Directions:
This requisition form must be completed and signed by the requestor and the department head and submitted to the
Appropriate Building Custodian and Vice Chancellor for their approval. The completed form must be submitted to
the Office of the Director of the Physical Plant. (For additional information/instructions see the University Key
Policy.)
1. Location of key and/or lock work:
Building: ______________________________ Department: ________________________________
A. Room Number: _____________ Door Number: _________________ Number of Keys: ________
Room Number: _____________ Door Number: _________________ Number of Keys: ________
Room Number: _____________ Door Number: _________________ Number of Keys: ________
Room Number: _____________ Door Number: _________________ Number of Keys: ________
B. Outside Door:
Yes _____ No _____ (Give Location) _________________________________
C. Sub-Master Key: Yes _____ No _____
2. Purpose of key(s) and lock work:
______ Additional Personnel
______ Replacement due to breakage
______ Additional Security
______ Replacement for lost/stolen keys (if Lost/Stolen) Date lost or stolen reported to security: ___________
______ Other (Give Reason) __________________________________________________________________
3. Lock Work Requested:
______ Re-key cylinder - new key change.
______ More than one lock to be keyed alike on master system.
______ More than one lock to be keyed alike off master system.
Approvals: (As Required - see University Key Policy)
Date Requested
___________ Requestor: ________________________ Dept. Head:______________________
:
Dean: _______________________________ or Area Supervisor: _____________________________________
Vice Chancellor:____________________________ Building Custodian: _______________________________
Director of the Physical Plant: __________________________________
Date Completed by Locksmith: ________________ Locksmith: ______________________________________
Issuing Personnel: ___________________________ Received By: ____________________________________
Number of Keys and/or lock work:
No. of door keys received:
_______ Signature of Person Receiving Keys: ________________________
No. of sub-master keys received:
_______ Signature of Person Receiving Keys: ________________________
No. of outside door keys received: _______ Signature of Person Receiving Keys: ________________________
Comments/Explanations:
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PP_KLR(4/97)