HARVARD POLICE
40 Ayer Road
Harvard, MA 01451
(978) 456-1212
Fax: (978) 456-8313

REQUEST FOR SECURITY CHECK


Dispatcher: ______

Address: _______________________ Name: _________________ Phone: _____________

Leave Date: ______________ Return Date: _______________

Res. _____ Bus. _____ Other: _____

Lights? Yes [ ]     No [ ]     Name: _____________ Add: _____________________

Keys W/Anyone? Yes [ ]     No [ ]     Name: ___________ Add: ________________

Phone: ____________________

Any Workers on Premises During Absence? Yes [ ]     No [ ]

Name: ______________________________

Vehicles in Driveway? Yes [ ]     No [ ]

Reg#: _______ Description: _______________________________

Emergency Information: c/o Name: ______________________ Add: ________________

Phone: ________________________     Alarm: Yes [ ]     No [ ]

Officer's Security Check Report

Date:       Time:       State if Premises Secure or Other*        Off. Init.
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________