Free form template · Word

System Access Request

A system access request form is used to ask for a user ID or role on internal systems such as servers, domain groups, shared drives or databases. It records exactly what access is needed and why, and routes the request through the reporting manager, system owner and IT security before anything is granted.

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[Company Logo][Company Name]

SYSTEM ACCESS REQUEST FORM

Request No.:: [Reference Number]
Date:: [Date]
Request Type:: New / Modify / Temporary / Elevated
Ticket Ref.:: [Ticket Number]

1. Requester Details

Name	[Employee Name]
Employee ID / Vendor ID	[Employee ID]
Designation	[Designation]
Department	[Department]
Reporting Manager	[Reporting Manager]
Existing User ID (if any)	[User ID]
User type: Employee / Contractor / Vendor engineer

2. Access Requested

System / Server / Resource	Role or Group	Access Level	From	To	Business Justification
[Domain / Active Directory group]	[Group Name]	Read / Write / Admin	[DD/MM/YYYY]	[DD/MM/YYYY]	[Justification]
[File server / shared drive path]	[Folder]	Read / Write	[DD/MM/YYYY]	[DD/MM/YYYY]	[Justification]
[Server name / IP]	[Role]	Read / Admin	[DD/MM/YYYY]	[DD/MM/YYYY]	[Justification]
[Database]	[Schema / Role]	Read / Write	[DD/MM/YYYY]	[DD/MM/YYYY]	[Justification]

3. Approver Chain

Level	Approver	Name	Decision / Comments	Date
1	Reporting Manager – business need	[Reporting Manager]	Approved / Rejected – [Comments]	[DD/MM/YYYY]
2	System Owner – role appropriateness	[System Owner Name]	Approved / Rejected – [Comments]	[DD/MM/YYYY]
3	IT Security – required for admin / production access	[IT Security Name]	Approved / Rejected – [Comments]	[DD/MM/YYYY]

4. Provisioning (IT use)

System	User ID	Access Granted	Granted On	Granted By	Auto-expiry Set
[System]	[User ID]	[Role / Level]	[DD/MM/YYYY]	[IT Executive Name]	Yes / No
[System]	[User ID]	[Role / Level]	[DD/MM/YYYY]	[IT Executive Name]	Yes / No

5. User Undertaking

I will use this access only for the purpose stated above.
I will not share my credentials or let others use my session.
I will inform IT when I no longer need the access.
I understand that my activity on these systems is logged and may be reviewed.

Requester
[Employee Name]
Date: [Date]

Provisioned by
[IT Executive Name]
IT Department
Date: [Date]

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What this template includes

Clear list of systems with the specific role or permission level
Business justification for each line
Read, write or admin level, to support least privilege
Start and end dates for temporary access
Three-level approver chain
Provisioning record for audit

When to use it

A new joiner needs access to team systems beyond the standard kit
An employee changes role and needs different permissions
Temporary elevated access is needed for a project or audit
A vendor engineer needs time-bound server access

How to customise this template

1Pre-fill the systems list with your main platforms
2Define standard role names so requesters pick, not invent, roles
3Name the system owner for each platform
4Add a security review step for admin or production access
5Use the application access request form for business apps

HR tips

Never approve admin access without an end date
Reject requests that say only 'needed for work'; ask for a specific reason
Keep the signed form linked to the user ID in your ticket tool
Review temporary access on its end date, not at the next audit

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Frequently asked questions

Who approves a system access request?+

The reporting manager confirms the business need, the system owner confirms the role is appropriate, and IT security reviews privileged or sensitive access before IT provisions it.

What is least privilege access?+

It means giving a user only the minimum access needed to do their job, for the minimum time required.

How long should temporary access last?+

Only as long as the task needs. Put a specific end date on the form so access can be removed automatically or on review.

All 50 it assets, admin & company property →

[Company Logo][Company Name]

SYSTEM ACCESS REMOVAL FORM

Request No.:: [Reference Number]
Date:: [Date]
Trigger:: Exit / Transfer / Contract End / Access Expiry / Access Review Finding
Effective Date and Time:: [DD/MM/YYYY] [HH:MM]

1. User Details

Name	[Employee Name]
Employee ID / Vendor ID	[Employee ID]
Department	[Department]
Primary User ID	[User ID]
New Department (if transfer)	[Department]
Requested by	[HR Name] / [Reporting Manager]

2. Access to be Removed

System / Resource	User ID / Role	Action	Removed On (Date / Time)	Removed By
Domain / directory account	[User ID]	Disable / Delete / Remove group	[DD/MM/YYYY HH:MM]	[IT Executive Name]
File server / shared drive	[Folder / Group]	Remove	[DD/MM/YYYY HH:MM]	[IT Executive Name]
Server / cloud console	[Role]	Remove	[DD/MM/YYYY HH:MM]	[IT Executive Name]
Database	[Role]	Remove	[DD/MM/YYYY HH:MM]	[IT Executive Name]
Remote access / VPN	[User ID]	Revoke	[DD/MM/YYYY HH:MM]	[IT Executive Name]

3. Access to be Retained (transfers only)

Form · Word

System Access Removal Form

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[Company Logo][Company Name]

VPN / REMOTE ACCESS REQUEST FORM

Request No.:: [Reference Number]
Date:: [Date]
Request Type:: New / Extension / Vendor / Temporary (travel)

1. User Details

Name	[Employee Name]
Employee ID / Vendor ID	[Employee ID]
Designation	[Designation]
Department	[Department]
Reporting Manager / Vendor Coordinator	[Reporting Manager]
Vendor Company and Contract Ref. (if vendor)	[Vendor Name] / [Reference Number]
Mobile for MFA	[Mobile Number]

2. Reason for Remote Access

Approved hybrid / remote work arrangement
On-call or after-hours support
Business travel
Vendor maintenance or support
Other: [Specify]

3. Device Details

Form · Word

VPN Access Request

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[Company Logo][Company Name]

APPLICATION ACCESS REQUEST FORM

Request No.:: [Reference Number]
Date:: [Date]
Request Type:: New User / Additional Role / Change in Limit / Remove Role

1. User Details

Name	[Employee Name]
Employee ID	[Employee ID]
Designation	[Designation]
Department	[Department]
Branch / Location	[Work Location]
Reporting Manager	[Reporting Manager]
Official Email	[Email ID]

2. Application and Role Details

Application	Module	Role (from catalogue)	Data Scope (Company / Branch / Territory)	Approval Limit (₹)	Justification
[ERP / Accounting Software]	[Module]	[Role Name]	[Company Code / Branch]	[Amount]	[Justification]
[CRM]	[Module]	[Role Name]	[Territory]	-	[Justification]
[HRMS / Payroll]	[Module]	[Role Name]	[Entity]	-	[Justification]

Access required from	[DD/MM/YYYY]
Access required till: Permanent / [DD/MM/YYYY]
Licence type: Full / Limited / View-only

Form · Word

Application Access Request

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[Company Logo][Company Name]

DATA ACCESS REQUEST FORM

Request No.:: [Reference Number]
Date:: [Date]
Access Type:: One-time Extract / Recurring Report / Read Access to Database / Share with Vendor

1. Requester

Name	[Employee Name]
Employee ID	[Employee ID]
Designation	[Designation]
Department	[Department]
Reporting Manager	[Reporting Manager]

2. Data Requested

Dataset / system / report name	[Dataset Name]
Data owner	[Data Owner Name]
Classification: Internal / Confidential / Restricted
Period covered	[DD/MM/YYYY] to [DD/MM/YYYY]
Frequency: One-time / Weekly / Monthly

Field / Column	Needed for	Personal Data?	Masking Acceptable?
[Field Name]	[Purpose]	Yes / No	Yes / No
[Field Name]	[Purpose]	Yes / No	Yes / No
[Field Name]	[Purpose]	Yes / No	Yes / No
[Field Name]	[Purpose]	Yes / No	Yes / No

Form · Word

Data Access Request

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[Company Logo][Company Name]
FACILITY ACCESS REQUEST FORM
Request No.:
[Reference Number]
Date of Request:
[Date]
Facility / Site:
[Work Location]
Access Type:
After hours / Weekend / Holiday / Other site / Special area
1. Requester
Name [Employee Name]
Employee ID [Employee ID]
Designation [Designation]
Department [Department]
Mobile Number [Mobile Number]
Supervising employee on site [Employee Name]
2. Access Details
Date(s) [DD/MM/YYYY] to [DD/MM/YYYY]
Time [HH:MM] to [HH:MM]
Areas required [Floor / Room / Warehouse / Training Hall]
Purpose [Purpose]
3. People Entering
Form · Word
Facility Access Request
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Date(s)	[DD/MM/YYYY] to [DD/MM/YYYY]
Time	[HH:MM] to [HH:MM]
Areas required	[Floor / Room / Warehouse / Training Hall]
Purpose	[Purpose]

[Company Logo][Company Name]

ACCESS CARD ISSUE FORM

Request No.:: [Reference Number]
Date:: [Date]
Site / Building:: [Work Location]
Request Type:: New / Additional Access / Replacement / Temporary

1. Card Holder Details

Name	[Employee Name]
Employee ID / Vendor ID	[Employee ID]
Designation	[Designation]
Department	[Department]
Category: Employee / Contractor / Intern / Consultant
Shift Timing	[Shift Timing]

2. Access Required

Zone / Door	Required (Yes/No)	Days	Time Window	Business Justification
Main entrance and reception	Yes / No	Mon–Sat	[HH:MM] to [HH:MM]	[Justification]
Floor [Floor] work area	Yes / No	[Days]	[HH:MM] to [HH:MM]	[Justification]
Server / network room	Yes / No	[Days]	[HH:MM] to [HH:MM]	[Justification]
Store / record room	Yes / No	[Days]	[HH:MM] to [HH:MM]	[Justification]
Parking / basement	Yes / No	[Days]	[HH:MM] to [HH:MM]	[Justification]

Access valid from	[DD/MM/YYYY]
Access valid till	[DD/MM/YYYY] / Until exit

Form · Word

Access Card Issue Form

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[Company Logo][Company Name]
ACCESS CARD RETURN AND DEACTIVATION FORM
Ref. No.:
[Reference Number]
Date:
[Date]
Site / Building:
[Work Location]
Return Type:
Full Surrender / Partial Zone Withdrawal
Card Holder
Name [Employee Name]
Employee ID / Vendor ID [Employee ID]
Department [Department]
Reason: Exit / Contract End / Transfer / Role Change / Card Damaged
Effective Date and Time [DD/MM/YYYY] [HH:MM]
Card Surrendered
Card No. Card UID / Serial Physically Returned Condition Disposal
[Card Number] [Serial Number] Yes / No Good / Damaged Reuse / Destroy
Zone Access Revoked
Form · Word
Access Card Return Form
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Card No.	Card UID / Serial	Physically Returned	Condition	Disposal
[Card Number]	[Serial Number]	Yes / No	Good / Damaged	Reuse / Destroy

[Company Logo][Company Name]

EMAIL ACCOUNT CREATION REQUEST

Request No.:: [Reference Number]
Date:: [Date]
Requested by:: [HR Name] / [Reporting Manager]
Required by:: [DD/MM/YYYY]

1. Request Type

New employee mailbox
Contractor / consultant mailbox (time-bound)
Shared / functional mailbox (e.g. support@)
Additional alias / name change

2. User Details

Full Name	[Employee Name]
Employee ID / Vendor ID	[Employee ID]
Designation	[Designation]
Department	[Department]
Date of Joining	[Date of Joining]
Work Location	[Work Location]
Personal email for credential delivery	[Personal Email]
Mobile for MFA setup	[Mobile Number]

3. Mailbox Details

Form · Word

Email Account Creation Request

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System Access Request

Preview of the form

1. Requester Details

2. Access Requested

3. Approver Chain

4. Provisioning (IT use)

5. User Undertaking

What this template includes

When to use it

How to customise this template

HR tips

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Frequently asked questions

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