Access Provisioning Request and Approval Form

Request and approve new user access to a system, role, or resource with business justification and audit trail.

Request Details

• Requested system or application
  Enter the system, application, or shared resource that access is needed for.
• Type of access requested
  Select the access category that best matches the request.
• Requested role or permission level
  Specify the role, permission set, or access level needed.
• Access duration
  Required only for temporary access requests.
• Access end date
  Show only when temporary access is selected. Use a date picker for the requested end date.

Business Justification

• Business justification
  Describe the business need for access and how it supports the user's job responsibilities.
• Impact if access is not granted
  Optional. Describe any operational impact if the access is delayed or denied.
• Data or systems that will be accessed
  Select the categories of data or systems this access will touch. Collect only what is necessary for review.
• Will this access include PII or sensitive data?
  This helps route the request for appropriate review and controls.

Requester Information

• Requester name
  Name of the person submitting the request.
• Requester email
  Work email address for status updates and follow-up.
• Department
  Department or team associated with the request.
• Manager or business owner
  The approver responsible for validating the business need.
• Manager or business owner email
  Work email address for approval routing.

Approval and Security Review

• Approval decision
  Select the current review outcome.
• Approver name
  Name of the person approving or reviewing the request.
• Approval date
  Date the approval decision was made.
• Security review required
  Check if the request needs additional security or compliance review.
• Security review notes
  Add any restrictions, compensating controls, or follow-up actions.
• Provisioning ticket or reference ID
  Optional. Link this request to an ITSM or access management ticket.

Acknowledgement

• I confirm the information provided is accurate and that access will be used only for approved business purposes.
  Required acknowledgement before submission.
• I understand this form may contain PII and consent to its use for access provisioning and audit trail purposes.
  Consent language for any PII collected in the request.
• Signature
  Optional digital signature for additional accountability.