2. 
4. TYPE OF ACCESS REQUEST

6. All requests for access control permissions to any Washington County buildings require the Department Head or authorizing official to complete and submit this form accordingly. All questions or requests for additional information should be addressed to fobaccess@washingtoncountyny.gov - requests for FOB access changes will not be processed by phone.

8. Select All that Apply:

   1. New FOB Request
   2. Report Lost / Stolen FOB
   3. Replacement FOB Request
   4. Change of Access (Add / Remove)
   5. Activate Vendor FOB **Include Details in Notes**
   6. Request for FOB Activity / Detail Report **Include Details in Notes**
10. DEPARTMENT HEAD / AUTHORIZING OFFICIALS INFORMATION
12. Department Head / Authorizing Official:
13. E-Mail Address:
15. Department Head / Authorizing Official Phone:
17. EMPLOYEE / VENDOR BUILDING ACCESS IS BEING REQUESTED FOR
19. Access is being requested for (First and Last Name):
21. Employee / Vendor's Job Title:
23. Department Assigned to:
    -- Select One --Alternative SentencingAssigned CounselBoard of ElectionsBoard of SupervisorsBuildings & GroundsCode EnforcementCornell Cooperative ExtensionCounty AdministrationCounty AttorneyCounty ClerkDistrict AttorneyEconomic Opportunity CouncilInformation TechnologyCommissioner of JurorsLDC / PlanningOCA / NY CourtsPersonnelPublic DefenderPublic HealthPublic SafetyPublic WorksReal PropertySafety OfficerSewer DistrictSheriff's OfficeSocial ServicesTreasurer's OfficeVeterans ServicesWeights & MeasuresVendor / Other (include in notes)
25. Level of Access Requested (check all that apply):

    1. General Employee / Building Access
    2. Department Specific Access (General)
    3. Department Specific Access (Supervisor)
    4. Other **Include Details in Notes**
    5. Disable FOB / Remove All Access
27. Specific Request Information / Additional Notes (include any notes / details specific to your request):
Leave This Blank:


31. Submit

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