Video Documentation and Surveillance Acquisition Proposal Form                                                    Attachment II

 

Contact Information

 

Department:

 

Full Name (Last, First, M.I):

 

Work Phone:

 

E-Mail Address:

 

 

Describe the Area and Activity

Describe location for video surveillance (i.e., building, interior, exterior, warehouse, point of sale, etc.)

 

 

Describe the patrons using the area (i.e., students, faculty, staff, etc.)

 

 

Reasons Why Video Recording is Needed

 

 

Physical Security

Business

 

Academic

Hybrid

 

 

 

Describe the purpose and goal for needing video surveillance.

 

 

 

 

Describe any previous incidents in the area.

 

 

Agreement and Signature

By submitting this application, I affirm that the facts set forth in it are true and complete.

 

Name (printed)

 

Signature

 

Date

 

 

Actions and Tracking

 

 

 

Complete

Action:

Start Date:

 

Completion Date:

 

o     

Plans Received

 

 

 

 

o     

Supervisor, Access Services Review

 

 

 

 

o     

STAG Review

 

 

 

 

STAG Recommendations

 

 

 

 

 

 

Approval

Signature

Print Name

Date

 

Director of University Police

 

 

 

 

Chair (if needed)

 

 

 

 

Vice President for Student Affairs (if needed)

 

 

 

 

Office of Provost

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

This document is FOR OFFICIAL USE ONLY.  It contains information that may be confidential under Chapter 418 of the Texas Government Code and may be exempt from public release under the Texas Open Records Act/Public Information Act (Texas Government Code Chapter 552) and Freedom of Information Act (5 U.S.C. 552). This document is to be controlled, handled, transmitted, distributed, and disposed of in accordance with university policy relating to open records information and is not to be released to the public or other personnel who do not have a valid "need-to-know" without prior approval of the Director, University Police Department, Texas State University-San Marcos.