ACHIEVING SECUIRTY AND SAFETY Intake FormToday's Date* MM slash DD slash YYYY Requesting Department* Contact Name* First Last Phone*Email LocationCampusStorrsAvery PointFarmingtonHartford DowntownHartford Law SchoolStamfordWaterburyBuilding Name* Room Number* Security Components Requested Camera Card Reader Alarm Blue Emergency Telephone Why are these device(s) needed? Please explain.Access required outside business hours?* Yes No Please specify name KFS Number Funding source - NOTE: departments are required to cover installation costs with very few exceptions.Has department head or supervisor approved this installation request?* Yes No Department Head Name* First Last Department Head Email* After submitting this form, University Safety will conduct a security assessment and make recommendations for security needs. Once the assessment is reviewed and approved, Facilities Operations will coordinate bids, vendors and installation of security components.EmailThis field is for validation purposes and should be left unchanged.