Loyola University Chicago

Contractor's Clearance

Department of Campus Safety
Loyola University Chicago · Phone: 773.508.6039 · Fax: 773.508.6042 · E-mail: asksafety@luc.edu

I request access for the contractor listed below and hereby authorize access to the building(s) or areas indicated
Today's Date
Requestor's Name
Department
E-Mail
Phone
Date(s) of Clearance
Contractor
Phone
Service Person(s)
Pager / Cell Phone #
Loyola Property Affected
Building
Specific Room(s) or other location
Task
Normal Work Hours