Soochow University Library

Surveillance Footage Access Application Form

Date of application (dd/mm/yy) / / /

Office of Environmental Safety Handling Officer

Name	Department/ Level
Student number/ Identification number	Contact number
E-mail
Date/Time of occurrence	dd / mm / yy /( hh / mm： (hh:/ mm
Reason for application
Library Processing Report	□No suspicious activity found following viewing in the presence of a librarian □Suspicious activity found following viewing in the presence of a librarian □Others (please describe)： ※Prior to submission, the applicant should obtain a signature from the school's Security Department. ※The library shall keep a copy of the application form on file for record-keeping purposes. ※Library personnel are obligated to personally deliver a duplicate of the application form and a burned CD to the designated instructor for processing.
Librarian’s Note	□Reference and Periodical Area □Reading Room □Non-print materials room □B1 Systems Room