Employee Name:
,
Email:
Integrated System Access Form
DSC will be notified of receipt of this form within 2 days. If notification is not provided within that time frame, contact the HRD&T
training administrator. View the Business Rules document for detailed procedures for submitting a request. Items with an asterisk
are required. The form should be filled out on-line and then printed for signatures.
http://www.hrs.virginia.edu/career/dot/oraclebusrules.htm
Section I. Employee Information
*Last Name:
*Messenger Mail Address:
*First Name:
Middle Init.:
*Registered Email Address:
*Employee Number:
*Office Phone:
Section II. Employment Information
*Employee Type:
U.Va. Salaried
U.Va. Temp/Wage
Medical Center
Other (see below)
*Employee Status:
New Employee
Transfer into Department
Current Employee
*Transfer out of Department
Termination
* Effective Date:
Outside Company, Foundation or Students: Please complete all of the following information, so that you can be entered into
the HR system. Company and foundation requests must be approved by the University Comptroller and Student requests will be
routed based upon responsibility requested.
*Organization Number:
*Organization Name:
Home Address:
Gender:
Company or Foundation Name:
*Transfer Out Of Department:
The signature in this box represents authorization to deactivate all active Integrated System responsibilities for the above named
individual with the exception of Employee Self Service. The only signature required to deactivate all Integrated System
responsibilities is the supervisor of record. Please sign below and submit this page only to the Training Administration Unit; P.O.
Box 400803; Charlottesville, VA 22904-4803 or fax to: Attn: Training Administration Unit, 434-924-6869
*Supervisor Signature :
Printed Name:
____
__________
Date:
Section III. Navigation Training
Integrated System Navigation and Overview is a required prerequisite for all responsibilities, with the exception of ODS
Specialist and UVA PO Shopper. However, it is strongly recommended for those responsibilities as well.
You may register for this course through UVA Employee Self Service in the Integrated System.
You must have taken the IS Navigation and Overview class prior to attending any other Integrated System classes.
Contact the Help Desk at 434-924-HELP(4357), option 2, if you need assistance registering for this class or for help with your
Integrated System password.
Section IV. Integrated System Responsibilities by Module
Instructions:
1. Go to the section for the Integrated System Module for which you need access.
2. Select the shaded field, Responsibility Name, the drop down list will appear. Select the desired responsibility. Refer to the
web page below for responsibility descriptions:
http://www.virginia.edu/integratedsystem/gettingStarted/ISResp/respindex.html
3. Select the 'Add' or 'Delete' check box to indicate which action applies to the responsibility name selected.
4. Enter all other information as required in the appropriate section(s).
Employee Name:
,
Email:
Employee Name:
,
Email:
Accounts Payable (AP)
Accounts Payable (AP)If the person is assigned AP P-Card Holder below and will reconcile purchasing card transactions for other
employees, please contact the Purchasing Card Administrator. The name of the current Purchasing Card Administrator is
available at: http://www.virginia.edu/procurement/about/StaffByArea.html
Responsibility Name: Select or Print
Responsibility Name: Select or Print
Action: Add
Action: Add
Delete
Delete
Accounts Receivable (AR)
Responsibility Name: Select or Print
Responsibility Name: Select or Print
Action: Add
Action: Add
Delete
Delete
Fixed Assets (FA)
Responsibility Name: Select or Print
Responsibility Name: Select or Print
Action: Add
Action: Add
Delete
Delete
Action: Add
Action: Add
Delete
Delete
Grants Accounting (GA)
Responsibility Name: Select or Print
Responsibility Name: Select or Print
General Ledger (GL) Is this a change to the Approver or Self-Approval Limits only? YES
(If 'Yes' go directly to 'Approval
Data.')
Responsibility Name: Select or Print
Action: Add
Delete
Responsibility Name: Select or Print
Action: Add
Delete
Approval Data: The fields below are only required for changes to Approver or Self-Approval limits and all GL responsibilities
except GL Viewer and GL Fin Reporting Administrator:
Employee’s Self Approval Limit:
$5,000
$250,000
$500,000
$5,000,000
$25,000,000
(no approver required)
Approver’s Name:
Approver’s Employee #
(Approver must have higher Self-Approval Limit than employee and must have a GL responsibility other than GL Viewer.)
Human Resources and Payroll (HR)
Responsibility Name: Select or Print
Responsibility Name: Select or Print
Responsibility Name: Select or Print
Responsibility Name: Select or Print
Action: Add
Action: Add
Action: Add
Action: Add
Delete
Delete
Delete
Delete
Labor Distribution (LD)
Responsibility Name: Select or Print
Responsibility Name: Select or Print
Action: Add
Action: Add
Delete
Delete
Employee Name:
,
Email:
Purchasing (PO) PO Purchaser and PO Requestor are automatically assigned the PO Shopper duties by default.
Selection of PO Shopper provides a $1 self-approval limit only. There are highly restrictive opportunities for a higher limit in
certain exceptional situations. To review the criteria for requesting higher limits, please visit
www.virginia.edu/integratedsystem/higherlimit.doc
Responsibility Name: Select or Print
Responsibility Name: Select or Print
Action: Add
Action: Add
Delete
Delete
Approval Data: Required for all Purchasing responsibilities with the exception of AP/PO Viewer and PO/AP/INV Closing.
Workflow Change Only:
Employee Position #:
Employee Self Approval Limits:
LPO:
Internal Requisition:
Purchase Requisition:
$1
$1
$1
$4999.99
$4999.99
$4999.00
Unlimited
Unlimited
Approver’s Name:
Approver’s Position #:
(Not required if employee has been given highest limit on all three self-approval limits.)
Discoverer
Responsibility Name: Select or Print
Responsibility Name: Select or Print
MISCELLANEOUS
Responsibility Name: Select or Print
Responsibility Name: Select or Print
Responsibility Name: Select or Print
Responsibility Name: Select or Print
Action: Add
Action: Add
Delete
Delete
Action: Add
Action: Add
Action: Add
Delete
Delete
Delete
Section V. Authorization
Instructions:
1. Determine which signatures are required.
2. Enter the Data Security Contact's (DSC) name and Email ID.
3. Authorizers sign below.
4. DSC will be notified of receipt of this form within 2 days. If notification is not provided within that time frame, contact the
OL&D training administrator.
*Authorizer:
*Signature:
*Printed Name:
*Reg. Email Address:
*Date:
*Supervisor
..............................................
.......................................................................................................
*Data Security Contact
..............................................
.......................................................................................................
Section VI. Submit Form
1. Scan and email the completed form with all required signatures to: ISAccess@virginia.edu
If necessary, forms may be delivered via messenger mail to: Human Resources, PO Box 400127
2. Keep a copy for your records.
3. If you have questions regarding your IS Access call 243-9541.
FOR UHR USE ONLY
Purchasing
Date
Hierarchy:
Approval:
Buyer:
Notes:
General Ledger
Date
Initials
Approval Limits:
Approver:
Initials
ELECTRONIC ACCESS AGREEMENT
Name (Please Print): ____________________________________________________________
Employer/Sponsor:
Medical Center
HSF
UVA Academic Division
Department:__________________________________ Date:___________________________
1.
I will not disclose my password to other individuals, and acknowledge that the combination of my computing ID and password is
considered equal to my electronic signature. I understand that I will be held responsible for the consequences of any misuse
occurring under my computing ID and password due to any neglect on my part.
2.
I will not use another person’s computing ID and password. If I have reason to believe that my computing ID and password, or
those of another individual have been compromised or are being used by a person other than the individual to whom they were
issued, I will immediately report it to the appropriate (UVA, Medical Center, or HSF) Information Security Office.
3.
I will immediately report any suspected breaches of confidentiality of highly sensitive data, including patient information, to the
appropriate Information Security and Compliance Offices.
4.
I agree to access and alter only the information for which I have responsibility or authorization, and not to view information that I
have no need to see as part of my responsibilities. Access to or use of a University, Medical Center or Health Services Foundation
information system and the data it contains for my own personal gain or profit, for the personal gain or profit of others, or to
satisfy personal curiosity is strictly forbidden.
5.
I will respect the confidentiality of individuals to whose information I have been given access. I will not view or disclose that
information except as required by my responsibilities and as allowed by University, Medical Center and Health Services
Foundation policies and applicable law.
6.
I understand that the transactions processed with my electronic access may be audited, and appropriate action will be taken if
improper uses are detected.
7.
I agree to follow the privacy, security, and other computing policies and procedures established by the University, Medical Center,
and Health Services Foundation, as well as state and federal security and privacy laws and regulations, that apply to the use of my
computing ID and password and to the information and the systems I access.
8.
I understand these concepts apply to both fixed and mobile devices (such as, but not limited to PDAs, Blackberrys, and textenabled pagers). I also agree to safeguard the information I access and the devices assigned to me and report any losses promptly
to the appropriate Information Security Office.
9.
My signature below indicates that I have read, understand, and agree to abide by these requirements. Failure to do so may result
in the revocation of my system privileges and/or disciplinary actions, including termination of my employment.
________________________________________
Signature
For employees, send to appropriate human resources department identified below (for Medical Center non-employees, attach to
Computing Services Access Request Form):
University of Virginia Human Resources
P.O. Box 400127
Charlottesville, Virginia 22904
434-924-4450
University of Virginia Health System
Human Resources
P.O. Box 800567
Charlottesville, Virginia 22908
434-982-4122
University of Virginia Health Services Foundation Human
Resources
500 Ray C. Hunt Drive
Messenger Mail Box 800504
Charlottesville, Virginia 22903
434-295-1000
March 2010. Reprints:
http://www.itc.virginia.edu/policy/form/eaa.pdf
https://www.healthsystem.virginia.edu/Intranet/security/Security_Forms/040310electronicaccessagreement1.pdf