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IT Request Form

This document is a user access and IT facility request form containing fields for a user's name, department, job title, location, as well as requests for IT facilities and equipment including software, PC type, internet access level, security access, printing and copying needs, file sharing permissions. The user and their coordinator must sign before the division head and IT team can approve and provision the requested access and facilities.

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I G. A. Ratna Dewi
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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21 views

IT Request Form

This document is a user access and IT facility request form containing fields for a user's name, department, job title, location, as well as requests for IT facilities and equipment including software, PC type, internet access level, security access, printing and copying needs, file sharing permissions. The user and their coordinator must sign before the division head and IT team can approve and provision the requested access and facilities.

Uploaded by

I G. A. Ratna Dewi
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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USER ACCESS & IT FACILITY REQUEST FORM

Tanggal / Date : Departemen / Dept :


Nama Lengkap / Full Name : Lokasi / Location :
Kepala Departmen / Division : Posisi / Job Title :

USER LOGIN & E-MAIL


Username : Password : Default

No IT Facility and Description


Equipment
Microsoft
1 Software HIS Q-PRO □ □ Other : □
Office
Desktop □ Notebook □ AIO Desktop □
2 PC
Spesifikasi A □ Spesifikasi B □ Spesifikasi C □
3 Internet Non Internet □ Internet □ Internet Plus □
4 Security Access VPN □ Remote App □ Other :
5 Print & Copy B&W □ Color □
* Note : …………………………………………..
File Sharing
Folder name : ……………………………………………………………………………………………………….. □ Create New

No Name Unit Read Modify Delete Create

1
2
3
Lain – lain / Other :

Pemohon Koordinator Unit Kepala TIM IT


Divisi/Departemen

Nama : Nama : Nama : Nama :


Catatan:

• Beri tanda ceklist atau tanda silang( untuk pemberian fasilitas (*) special case (**) based on Job Title

[Type her e] [Type her e] GA/IT/001-0323/00

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