Card Access Request Form

New and existing Lassonde students, faculty, and staff may use this form to request YorkU card access to rooms and labs. Please note that a copy of the submitted Card Access Request Form will be sent to the respective PI/Manager for verification.

Please ensure all fields are completed accurately, as errors may prolong the processing time.

If you are experiencing any issues with your current card/access, please contact Nick Plagaki at nickpl@yorku.ca for assistance.

Name Name First Last
Enter your first name and last name as it appears in your YorkU file
YorkU Email

Confirm Email Address
Department

Department Mechanical Engineering Civil Engineering Earth & Space Science & Engineering Electrical Engineering & Computer Science Dean's Office Student Welcome & Support Center Capstone Student Club/Other Student Club/Other
YorkU Status
Principal Investigator (PI)/Supervisor Name Principal Investigator (PI)/Supervisor Name First Last
PI/Supervisor Email Address

Confirm Email Address

A copy of the submitted Room Access Request Form will be sent to the respective PI/Supervisor for verification
Employee Number/Student Number
Must be 9 characters. Currently Entered: 0 characters.
Building and Room Number

Indicate BOTH the building name and room number you require access to
i.e. Bergeron, Room 215
Did you request and are authorized to access and of the following spaces:

Did you request and are authorized to access and of the following spaces: PSE 020 PSE 020D PSE 020F PSE 021 PSE 021A PSE 022
PSE 020/020D/020F/021/021A/022 Facility User Agreement
By checking off the boxes below, I attest:

By checking off the boxes below, I attest: I have read the Lassonde School of Engineering Petrie Science and Engineering Building Shared Research Space Governance Document, hereafter referred to as the ‘the Document’. I understand that I share with all other authorized users, the responsibility for ensuring a safe work environment. I accept all provisions in the Document and agree to abide by all guidelines and procedures described. This includes but is not limited to: Taking responsibility for my actions Acquaint myself with and conduct my activities in accordance with all safety rules and safe operational procedures, consistent with the equipment operating instructions and/or facility rules Seek assistance from qualified personnel if I am not familiar with how to safely handle a hazardous material or piece of equipment Complete all required training as instructed by my PI Respecting boundaries of others including their workspace and property I understand I may be subjected to immediate work stoppage, removal from the Facility or other disciplinary actions, if I act in a manner that puts the Facility or others at risks, if I have violated the University’s policy, or if there is believe that my conduct is inappropriate.
Date until when you need access : Date until when you need access : / MM / DD YYYY

Until when you need to access
Day(s) and Time(s) of Access
Monday: Tuesday: Wednesday: Thursday: Friday: Saturday: Sunday:
Beside each applicable day, indicate your time of arrival and departure
i.e. Monday: 8 am to 4 pm.

Card access will be programmed based on your indicated days/times
For Labs access, please confirm that you have passed WHMIS 2

For Labs access, please confirm that you have passed WHMIS 2 Yes No Not Applicable
For Labs access, please confirm that you have passed Biosafety Training

For Labs access, please confirm that you have passed Biosafety Training Yes No Not Applicable

Card Access Request Form

Card Access Request Form

PSE 020/020D/020F/021/021A/022 Facility User Agreement