Hospital Security Camera Approval Form
Request Information
Date of Request
Requesting Department
Requestor Name & Title
Camera Installation Details
Location/Area
Purpose
Number of Cameras
Justification for Installation
Privacy Considerations / Measures
IT & Security Review
IT Infrastructure/Technical Review
Security Review Comments
Approval
Requestor Signature
Date:
IT Department Approval
Date:
Security Department Approval
Date:
Administration Approval
Date: