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?Device Start DateDevice Type (Access to card environment)LocationSerial #ModelSoftware VersionMAC AddressAssigned User Title/Name<Date device put in place><POS Terminal>< Building / Room/Jack><SR Number>< Model number><Software Version>N/A<Title><Date device put in place><computer>< Building / Room/Jack><SR Number>< Model number><Software Version><MAC><Title><Date device put in place><Smartphone>< Building / Room/Jack><SR Number>< Model number><Software Version><MAC><Title><Date device put in place><iPad, Netbook>< Building / Room/Jack><SR Number>< Model number><Software Version><MAC><Title><Date device put in place><Laptop>< Building / Room/Jack><SR Number>< Model number><Software Version><MAC><Title>Reviewer NameDateBrief Description for Change Log/Annual Review<Reviewer Name><Date><Annual PCI Review>Please complete, sign, and return to: Bursar’s Office Assigned User (Print name) ___________________________________California State University Sacramento6000 J Street Mail Stop 6052 Lassen Hall 1001 Responsible Administrator (Print name)__________________________Sacramento, CA 95819 Responsible Administrator Signature (Wet only)____________________916-278-6736 or bursar@csus.eduDate_______________________ ................
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