DEPT. :

Ref. : Date :

KEY PERMISSION

The following persons may be permitted to draw the key as per details given below

Sr.No. Name Design. Lan. Coad / Roll No. Specimen Sign
1.
2.
3.

ROOM PARTICULARS

ROOM NO. NAME OF LAB ROOM LOCATION OF THE ROOM KEY DEPOSITED AT

ROOM PARTICULARS

DATE TIME
FROM TO FROM TO

UNDERTAKING

  1. I shall responsible for safety of the equipment material in the room.
  2. I shall put off equipment, fans, light , AC etc. before closing the room.
  3. No outsider or person not authorised will be permitted in the room.
  4. I shall use thelab. Carefully and keep it nit and tidy.
  5. Key will be handled carefully and deposited back as soon as the work is over.

Signature of applicants

S.No. 1 S.No.2 S.No.3

Remarks of Guide/Lab. Incharge

1. Permitted during off working hours / holiday only. Yes / No
2. Permitted during working hours only. Yes / No
3. No time restriction Yes / No
4. Issue keys after depositing I card only Yes / No
5. Any other instruction Yes / No

Signature of Lab.Incharge


Permittd Approval of HOD

Office Seal Head of Department

Security Officer

ISSUE UPTO