This IT access request form collects employee information such as name, title, and location to request access changes including new hire access, temporary access, or terminating access. It also collects details on required access to resources like internet, email, printers, folders, drives and paths on the network. The form requires authorization from an approver with their signature before being submitted to the IT support team.

1. IT Access Request Form
Please email completed form to: itsupport@xxxxxxx.ca
EMPLOYEE INFORMATION
Employee Name: Employee Title:
Location: Date Requested:
ACCESS CHANGES/DATE
New Hire: Effective Date: Department:
Temporary
Effective Date: End Date: Department:
Access :
Terminate
Effective Date:
Access:
Suspend
Effective Date: End Date: Reason:
Access:
REQUIRED ACCESS
Internet: TELUS: Shaw:
E-mail
E-mail: Address: Webmail Address:
Printer Printer IP
Scan to E-mail: Name: Address:
Folder Folder
Scan to Folder: Name: Location:
Printer Printer
Print: Name: Location: USB: Networked:
Smart Phone: Make: Model:
Notes:
© 2009 HIT Business Solutions Inc. version 1.0 1

2. REQUIRED NETWORK ACCESS:
Drive Letter(s): Example: X:
Path: Example: FinanceAccountsPayable
Path:
Path:
Access: Read Read and Write
Notes:
AUTHORIZATION
Approved by:
Signature: Date:
Please email completed form to: itsupport@xxxxxxx.ca
© 2009 HIT Business Solutions Inc. version 1.0 2