Please Print	EMPLOYEES	CONTRACTORS

EMPLOYEE NAME ___________________________________	ORGANIZATION ________________________________________

POSITION	___________________________________	REPRESENTATIVE ________________________________________

SCHOOL ___________________________________	SCHOOL _________________________________________

PRINT NAME___________________________________

APPROVED BY	ISSUED BY	DATE	SIGNATURE

Please sign and return

ROOM NUMBER
HOOK NUMBER

I agree that I am personally responsible for all keys signed out to me, and will follow board policy relating to handing of keys listed on the reverse side. I have read and understand the guidelines.

RETURNED KEYS

CIRCLE & INITIAL ABOVE KEYS RETURNED

RETURNED BY DATE SIGNATURE

Reimbursement to the school district for the loss of a key is in accordance with the following:

Room keys	$20.00

Elevator keys	$20.00

Teacher/Gate keys	$30.00

School master keys	$50.00

District master keys	$100.00

RETURN FORM:	ATTN: MAINTENANCE DEPARTMENT- Randy Emerson

In accordance with Administrative Regulation 351 © referencing Campus Security.

The employee issued the key shall agree:

To be personally and monetarily responsible for the keys received as a staff member of the district

To permit no one to duplicate the key with knowledge or consent of employee

To assume full responsibility for the loss or damage resulting from the loaning of a key to any person

To notify the Principal or supervisor of any loss immediately after its occurrence

To reimburse the school district for the loss of a key in accordance with the following:

Room/Elevator keys	$20.00

Teacher/gate keys	$30.00

School master keys	$50.00

District master keys	$100.00

To cover the cost of re-keying locks if the loss of a key is judged to place rooms, buildings or campuses at risk

To return all keys to Principal or supervisor (reissued for 12 month employees) or end of employment procedures; all of the unpaid obligations to be cleared at that time

Persons losing keys shall immediately notify principal or supervisor either personally or by telephone. The Director of

Facilities, in consultation with the principal or supervisor, shall determine whether a replacement lock (s) should be

Installed.

The person losing the key (s) shall follow the verbal report with a written explanation of the loss of the key (s).

Subject report shall be submitted through administrative channels to the Director of Plant Operations.

Legal Reference:

EDUCATIONAL CODE 35294-35294.5 School safety plans

PENAL CODE

459 Unauthorized making, duplicating or possession of keys to public buildings

Maintenance Department 801 N. Mooney Blvd. Ste D. Visalia, CA 93291 Maintenance Division (559) 730-7589