Office of Information Technologies oit

Hard Drive & Magnetic Tape Destruction Request Form

Departmental Representative Contact Information

Name ______________________________________________ Department ______________________________________

Phone # ___________________________________________ Building ___________________________________________

Email ______________________________________________ Room # ___________________________________________

List of Media to Be Destroyed

If you have more than 5 items, list them in a separate document and attach the document to this form.

Item Type Manufacturer Model Identifying information

# (e.g., tape, (e.g., Seagate, (e.g., serial number, tape
hard disk) Maxtor) label)
1

Please return the media to me after it has been destroyed so that I can validate its destruction.

By signing this document, Departmental Representatives verify:

 They have read and agree to the Terms of Service (below)
 They are authorized to request the destruction of the items listed above
 The listed items were delivered to an OIT representative
 The listed items are intended for destruction and cannot be returned to the department with data
intact under any circumstance

Original to be kept by department. Copy of signed form required for OIT records.

Date of Media Collection: _______________________________________

___________________________________________________ __________________________________________________________
Dept. Rep. Name printed Dept. Rep. Signature

___________________________________________________ __________________________________________________________
OIT Rep. Name printed OIT Rep. Signature

___________________________________________________ __________________________________________________________
IPF Rep. Name printed IPF Rep. Signature

OIT Mgr Sign‐In Media Degaussed Media Destroyed Media Disposed/Returned

_______ __________ _______ ___________ ______ ___________ ______ _______________

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 Office of Information Technologies oit
Hard Drive & Magnetic Tape Destruction
Terms of Service
 OIT will follow industry guidelines for destruction of magnetic media that should ensure
complete erasure of data.

 OIT will handle and store all magnetic media submitted for destruction as if it contains
sensitive data.

 Once OIT collects magnetic media, the data on that media should be considered to be
destroyed and completely unrecoverable.

 OIT will not assume responsibility for sensitive data present on magnetic media collected
for destruction.

 OIT cannot validate that all data has been completely erased from submitted magnetic
media.

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