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Sample Security Policy and Maintenance Form › Sample Maintenance Form

Sample Maintenance Form

SECURITY
ADMINISTRATION
ACCESS AUTHORIZATION

 

DATE: PAGE:

___________ ____ _____
MM DD YY OF

USER TO BE AUTHORIZED:___________________ TYPE OF REQUEST:
[ ] ASSIGN OWNERSHIP
[ ] GRANT ACCESS
[ ] REVOKE ACCESS
[ ] TRANSFER OWNERSHIP TO _____

RESOURCE ACCESS REQUIREMENTS

 

 

 

 

 

 

 

 

RES
TYPE

RESOURCE NAME

ACCESS LEVELS

EXPIRY MMDDYY

TIMES OF DAY

DAYS

FACILITY

SPECIAL ACCESS THRU

PRIVPGM | LIBRARY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SPECIAL REQUIREMENTS & CONSIDERATIONS SECURITY USE ONLY

 

 

 

 

 

IMPLEMENTED BY:
DATE:

 

 

 

 

 

 

 

AUTHORIZATION
AUTHORIZATION
AUTHORIZATION

AUTHORIZED BY:
________________

DEPT:
______

SIGNATURE:
____________

TEL/EXT:
________

DATE:
______