Video Surveillance Operator Acknowledgement Form                                                                      Attachment IV


Operator Information


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


Texas State ID


Net ID


E-Mail Address:



     _____  1. I have read, understand, and will comply with the policies set forth in UPPS No. 05.04.05


     _____ 2.  I have completed the Video Surveillance Operator course.



Agreement and Signature

By initialing above, I acknowledge that I have read, understand, and will comply with the requirements in UPPS No. 05.04.05. I further affirm I will conduct my duties as a video surveillance operator in an ethical, professional, and legal manner.

Name (printed):














Operator Supervisor



Supervisor, Access Services













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.