Key-holder Agreement Form
The key issued remains the property of PICO.
The key is provided for the exclusive use of the keyholder who is individually named above, and is not to be passed to a third party without the consent of PICO and the completion of a further named agreement.
The key provided is not to be loaned or otherwise to leave the care of the keyholder named above.
Under no circumstances is the key to be duplicated.
Loss of the key is to be reported immediately to registered manager within PICO.
The keyholder will be responsible for the security of the key.
In the event of concerns by PICO in relation to the security of the key or the premises the facility may be withdrawn at any time.
In the event of loss of the key, or repeated loss of the key, PICO reserves the right to recover the cost of replacement keys / replacement locks from the staff member (not to be unreasonably applied).
The key held by all staff will be checked once every 6 months by PICO H&S Officer (Edoardo Spina).
In all cases the key will be returned to an authorised PICO keyholder who will countersign for the return on the staff member’s copy of the keyholder agreement, which will be returned to the staff member as a receipt.
The key will be returned to PICO on request.
Date of Issue
*
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Day
-
Month
Year
Date
Hour Minutes
Key Details
*
Staff Name
*
First Name
Last Name
Staff Signature
*
Issued By
*
Please Select
Edoardo Spina
Dr. Varna Kugan
Signature
*
Key Returns
Staff Signature upon key returned
Key returned to
Please Select
Edoardo Spina
Dr. Varna Kugan
Signature of manager accepting the return
Submit
Should be Empty: