VSS Request Form

Date (required)

Requesting Department (required)

Contact Person Name: (required)

Contact Person Email: (required)

Contact Person Extension (required)

Purpose of camera(s) (required)

Will the camera(s) record staff, students or members of the public as part of their normal function? (required)

Building Number (required) Building #

Cameras Location (required)

Are there multiple cameras to be installed within this room? (required)

Yes, we require multiple cameras

No, there is only one camera requested in this area

If you are requesting to install multiple cameras within the same room or area please indicate 'yes' below. Additional request boxes will be created for up to three cameras. If you require more than 3 cameras please submit using a separate request. NOTE: If your cameras are not to installed within the same enclosed area or room please submit one camera per request. For areas like hallways or public spaces if cameras are within sight of each other they can be submitted together in one request.

Please include as much detail as possible below. Each camera request must be submitted on a separate form unless an addditional camera is being requested in the same room or corridor (to a maximum of 3).

Camera Request #1 Location Details (required)

Camera Request #2 Location Details

Camera Request #3 Location Details

Rationale (required)