Door Access Control Device Request Form

This form is used to request new door access control devices or modification of existing devices.

1Request Type > 2Security Impact & Justification > 3Department Information > 4Floor Plan & Additional Information > 5ADMIN
Today's Date Today's Date / MM / DD YYYY
Are you requesting installation of a NEW Access Control Device?

Are you requesting installation of a NEW Access Control Device? Yes - I need a new device installed No - I want to modify an existing device

*Individual Access Issues?
Use the DOOR ACCESS REQUEST FORM to request badge access for yourself or others.

*Existing Device Issues?
Submit a Trouble Call to Facilities Management
Modification of Existing Access Control Hardware Request

Modification of Existing Access Control Hardware Request Remove or Relocate Existing Access Control Hardware (card reader | keypad | punch-code lock) Programming Modification to Existing Access Control Hardware (card reader) Electronic Code Change Punch-Lock Code Change
Card Access Control Hardware
Indicate the EXISTING Card Access Control type you are requesting to remove, relocated or program

Indicate the EXISTING Card Access Control type you are requesting to remove, relocated or program R-1 R-2 (HUGS) R-3 (Code Blue) R-4 R-5 R-6 R-7 None

Select NONE if not requesting modification of a card reader.

One selection is required
Indicate the NEW Card Access Control type you are requesting to install

Indicate the NEW Card Access Control type you are requesting to install R-1 R-2 (HUGS) R-3 (Code Blue) R-4 R-5 R-6 R-7 None

Select NONE if not requesting a card reader.

One selection is required
Electronic Wall-Mounted Keypads
Indicate the EXISTING Electronic Wall-Mounted Keypad you are requesting to remove or relocate

Indicate the EXISTING Electronic Wall-Mounted Keypad you are requesting to remove or relocate P-1 P-2 P-3 R-4 None

Select NONE if not requesting modification of an electronic wall-mounted keypad.

One selection is required
Door Handle Punch-Code Locks
Indicate the EXISTING Door Handle Punch-Code Lock you are requesting to remove or relocate

Indicate the EXISTING Door Handle Punch-Code Lock you are requesting to remove or relocate H-1 H-2 H-3 H-4 None

Select NONE if not requesting modification of a door handle punch-code lock.

One selection is required
Indicate the NEW Door Handle Punch-Code Lock you are requesting to install

Indicate the NEW Door Handle Punch-Code Lock you are requesting to install H-1 H-2 H-3 H-4 None

Select NONE if not requesting a new door handle punch-code lock.

One selection is required

Door Access Control Device Request Form

Door Access Control Device Request Form

Card Access Control Hardware

Electronic Wall-Mounted Keypads

Door Handle Punch-Code Locks