Hospital Mobile Device End-User Compliance Validation Form
User Information
Full Name
Department/Unit
Position/Title
Hospital Email
Device Information
Device Type
Smartphone
Tablet
Laptop
Other
Operating System
iOS
Android
Windows
macOS
Other
Device Model
Serial Number
Compliance Checklist
Device storage is encrypted
Device is secured with a passcode or biometric lock
Hospital security policy acknowledged
Up-to-date antivirus/anti-malware installed (if applicable)
OS and apps are updated to the latest version
Access to hospital systems is through approved apps only
Understands protocol for reporting lost or stolen device
Additional Comments
User Declaration
I confirm the above information is accurate and my device complies with hospital policies.
User Signature
Date