[Company Logo][Company Name]
- Ref. No.:
- [Reference Number]
- Date:
- [Date]
- Premises / Branch:
- [Work Location]
- Issue Type:
- Permanent / Temporary (leave cover) / Replacement
Key Holder
| Name | [Employee Name] |
|---|
| Employee ID | [Employee ID] |
|---|
| Designation | [Designation] |
|---|
| Department | [Department] |
|---|
| Mobile Number | [Mobile Number] |
|---|
| Temporary period (if applicable) | [DD/MM/YYYY] to [DD/MM/YYYY] |
|---|
Keys Issued
| Key No. / Tag Code | Lock / Door / Cabinet | Copies Issued | Duplicate Held By | Condition |
|---|
| [Key Number] | Main entrance / shutter | [Number] | [Admin Name] | [Condition] |
| [Key Number] | Store room / record room | [Number] | [Admin Name] | [Condition] |
| [Key Number] | Cabinet / pedestal [Seat Number] | [Number] | [Admin Name] | [Condition] |
| [Key Number] | [Other Lock] | [Number] | [Admin Name] | [Condition] |
Opening and Closing Duty (if assigned)
| Opening time | [HH:MM] |
|---|
| Closing time | [HH:MM] |
|---|
| Alarm code issued separately: Yes / No | |
|---|
| Back-up key holder | [Employee Name] |
|---|
Key Holder Undertaking
- I will keep the keys safely and not leave them on desks, in drawers or in vehicles.
- I will not lend the keys or allow anyone else to make copies.
- I will make no duplicate key without written approval from Admin.
- I will lock the premises properly and check shutters, windows and power switches at closing.
- I will report loss of any key immediately so that the lock can be changed if required.
- I will return all keys on exit, transfer, end of leave cover or when asked.
Approval
| Approver | Name | Signature | Date |
|---|
| Reporting Manager | [Reporting Manager] | [Signature] | [DD/MM/YYYY] |
| Admin / Branch Head (sensitive areas) | [Admin Name] | [Signature] | [DD/MM/YYYY] |
I acknowledge receipt of the keys listed above and accept responsibility for their safe custody.
Key Holder
[Employee Name]Date:
[Date]Issued by
[Admin Name]Administration
Date:
[Date]