Information System Access / Change Request Form
Employee Information
Current Date
-
Month
-
Day
Year
Date
Status
*
New Hire
Add/Change
Termination
Employee's Name
*
First Name
Last Name
Employee's Badge Number
*
Employee's Email Address
*
Supervisor's Name
*
First Name
Last Name
Supervisor's Badge Number
*
Supervisor's Email Address
*
Job Title
*
Department
*
Effective Date
*
-
Month
-
Day
Year
Date
Site Location
*
Select Location
Riceboro
Midway
Plaquemine
Perlington
Flopam
Other
Other Site Location
*
Country, State, City, Facility Name
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Information System Access / Change Request Form
Systems Access/Changes
*
Equipment (Computers & Phones)
Software (Omnis, D365, Safety, ETC.)
Mapped Drives
Assign/Change Email Domain
Review all areas
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Information System Access / Change Request Form
Equipment Information
Does the employee need a telephone?
*
Yes
No
Telephone Type
*
Telephone Extension
Mitel Desk Telephone
Cell Phone Request (May require further approval)
Other
Cell Phone Type
*
Apple OS
Android OS
Does the employee need a computer?
*
Yes
No
Computer Type (select all that apply)
*
Desktop
Laptop
Is there an existing employee with user permissions that can be mirrored?
*
Yes
No
Similar Individual's Name
*
Computer's Name
*
1. Click Start 2. Click Settings 3. Click System 4. Click About 5. Device name
Software Information
Systems (select all that apply)
Omnis
D365
SAP
Adobe Standard
Internet Access Only
Other (May require further approval)
Safety Systems (select all that apply)
GoCanvas
Brady 360
Pure OHS (Safety group only)
ProWatch
ExacqVision
Convergence
ISNetworld
VelocityEHS
Other (May require further approval)
If Omnis access is needed, what current Omnis Employee should the individual have similar access to?
*
Name of Current Employee
If D365 access is needed, is the new employee replacing a D365 Employee?
*
Yes
No
Name of employee the new employee is replacing in D365.
*
Name of Employee Replacing
If D365 access is needed, what current D365 Employee should the individual have similar access to?
*
Name of Current Employee
Mapped Drive(s)
*
F
G
K
U
Other (May require further approval)
Email domain
*
snf.com
polydyneinc.com
axchemusa.com
hychem.com
By requesting this access, you acknowledge that you have read and understand the computer resources, email, and telephone policies located in the Employee Handbook.
Submit
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