EASTERN	Oregon University--------------------------------------------------------Physical Plant
				962-3562
	LOST/STOLEN KEY REPORT FORM
To:Physical Plant
Date: _______________________
From: _____________________________		Soc. Sec. #:
Name of Key Holder				Name
[] Faculty[] Staff[] Student[] OtherKeys were: ()Lost()Stolen
Location lost/stolen:
List lost/stolen keys:
Building	Space No.	Key No.		Key Code No.
	IF MORE SPACE IS NEEDED USE BACK OF FORM
Key Holder's Signature				Date
Dean, Director or Unit Head's Signature				Date
FACILITIES & PLANNING USE ONLY:
Date Report Received:		Was area rekeyed?()Yes()NoCost:
Facilities & Planning Signature				Date
8/24/00