checklist

							                                                         Academic Health Center
                                                        Security Access Checklist

This checklist is designed for the employee and supervisor to review and initial as security access information and items are authorized,
transferred and/or terminated. The information should be completed when an employee is 1) being hired into the AHC, 2) transferring
departments within the AHC/University, or 3) terminating employment from the University.

Employee name ________________________________________________________(please print)

Department issueing information/items __________________________________________

                                                Authorization                     Transferred                      Returned/Terminated
                                                 Initials/Date                    Initials/Date                         Initials/Date
                                                        Supervisor/                       Supervisor/                             Supervisor/
                                            Employee   Administrator        Employee     Administrator              Employee     Administrator
Information/Items:
                      Office key(s)
                    AHC ID Badge
                   UM Access card
                        SECURID
          Novell password for login
    Enterprise password (PeopleSoft, FFN)
                    Forms Nirvana
         Data Warehouse password
                HRTS II password
                     IDX password
               Voicemail password
                   email password
          Meeting Maker password
                      Parking card
     UM Purchasing card (MasterCard)
      UM Corporate Travel MasterCard
                      UM Phone card
                         UM Beeper
                      UM Cell phone
                            U Card                                            N/A            N/A                      N/A            N/A

Departmental-specific Security Access
1
2
3
4
5

UM Equipment off-site
                   Fax machine
              Computer/laptop
                         Other


Employee Statement:




Supervisor Statement:                                                                             99711dac-1256-4559-b93c-7934f696698d.xls
          Academic Health Center
         Security Access Checklist

rized,




                                     99711dac-1256-4559-b93c-7934f696698d.xls