Day Access Request
This form is to grant the requested access between the hours of 7:30am – 4:00pm week
days only. Please make a copy of this form with requester’s picture ID in the space
provided below. Then fill in all information. This form will be kept in the key checkout
book at FM. This info will be retained in the book for the duration of the user’s time on
campus.
Approved by ________________________________________Department ___________
(CSM employee printed name)
__________________________________________________________
(CSM employee signature)
Date ________________
These keys are for day use only, but can be approved for check out daily for a period of
time.
From _______________ To _________________
Company ________________________________
Grant access to this building(s) _________________________________
FM Office personnel ___________________________________
Copy driver’s license or company ID Below
(Place this form on copier screen with I D below and copy).