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Employee Access Authorization Form

This form authorizes an employee, Maalvika Singh, to have access to certain restaurant management systems and payment functions. It specifies that the access does not grant access to cardholder data as that data is encrypted. It lists the systems and level of access required and provides spaces for the employee, director, and security head to authorize the access.

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Maalvika Singh
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37 views1 page

Employee Access Authorization Form

This form authorizes an employee, Maalvika Singh, to have access to certain restaurant management systems and payment functions. It specifies that the access does not grant access to cardholder data as that data is encrypted. It lists the systems and level of access required and provides spaces for the employee, director, and security head to authorize the access.

Uploaded by

Maalvika Singh
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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CRM Case Number: ______________________________

Employee Access Authorization Form to CDE

The purpose of this form is to authorize employees of the company to have access to Restaurant Management Systems that
interact with payment functions that tie within PCI scope.

Access does not grant employee access to cardholder data, as this data is encrypted and retained by NCR (through a P2PE
solution) and OLO (encrypted payment solution on bobevans.com).

Employee Information

Maalvika Singh
Employee Name:

[email protected]
Employee Email:

 Information
 Finance  Operations  Human Resources
Employee Department: Technology
 Legal  Marketing  Purchasing

Access Required (check all that apply)

 BER Restaurant Management Network (Jumpbox)  Network Security Appliances


 BEComp Azure Tenant  Panorama (Palo Alto Management)
 Production Environment  Meraki Dashboard (Switch Management and
 Development Environment MDM)
 VPN Access  Fortimanager and Fortianalyzer
 VHQ  Aloha Command Center
 Other (please explain):

Specify the level


 Read-only  Read/write  Administrator
of access required:

Access Authorization

Maalvika Singh 10-06-2022


Employee Name:
Date:
(print and sign)

Director Name:
Date:
(print and sign)

Director of
Cybersecurity OR
CIO/SVP of IT Date:
Signature:
(print and sign)

Employee Access Authorization Form to CDE Version 1.2

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